Visualizing PreOsteoarthritis: Integrating MRI UTE‐T2* with Mechanics and Biology to Combat Osteoarthritis The 2019 Elizabeth Winston Lanier Kappa Delta Award

Osteoarthritis (OA) is a leading cause of pain and disability for which disease modifying treatments remain lacking. This is likely because the symptoms and radiographic changes of OA occur after the onset of irreversible changes. Defining and treating earlier disease states are therefore needed to delay or halt OA progression. Taking this concept a step further, study of OA pathogenesis prior to disease onset by characterizing potentially reversible markers of increased OA risk to identify a state of "pre-osteoarthritis (pre-OA)" shifts the paradigm towards OA prevention. The purpose of this review is to summarize the 42 manuscripts comprising the 2019 Kappa Delta Elizabeth Lanier Award where conceptualization of a systems-based definition for "pre-osteoarthritis (pre-OA)" was followed by demonstration of potentially reversible markers of heightened OA risk in patients after anterior cruciate ligament (ACL) injury and reconstruction. In the process, these efforts contributed a new MRI method of ultrashort echo time enhanced (UTE) T2* mapping to visualize joint tissue damage prior to the development of irreversible changes. The studies presented here support a transformative approach to OA that accounts for interactions between mechanical, biological, and structural markers of OA risk to develop and evaluate new treatment strategies to delay or prevent the onset of clinical disease. This body of work was inspired by and performed for patients. Shifting the paradigm from attempting to modify symptomatic radiographic OA towards monitoring and reversing markers of "pre-OA" opens the door for transforming the clinical approach to OA from palliation to prevention. This article is protected by copyright. All rights reserved.