Multimodal photoacoustic arthroscopy for quantitative morphomechanical assessment of articular cartilage
5 affiliations
- 1Orthopedic Medical Research Center, Department of Orthopaedics, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515063, China
- 2MOE Key Laboratory of Laser Life Science & Institute of Laser Life Science, College of Biophotonics, School of Optoelectronic Science and Engineering, South China Normal University, Guangzhou, 510631, China; Guangdong Provincial Key Laboratory of Laser Life Science, College of Biophotonics, School of Optoelectronic Science and Engineering, South China Normal University, Guangzhou, 510631, China
- 3Orthopedic Medical Research Center, Department of Orthopaedics, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515063, China; Department of Sports Orthopaedics, TUM University Hospital, Technical University of Munich, Munich, Germany
- 4Areas of Excellence Centre for Musculoskeletal Degeneration and Regeneration, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; Corresponding author. Room6, 1F, Orthopaedic Learning Centre, North Wing of Li Kashing Clinics Building, Prince of Wales Hospital, Sha Tin, Hong Kong, China.
- 5Orthopedic Medical Research Center, Department of Orthopaedics, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515063, China; Corresponding author. Department of Orthopedics Surgery, The First Affiliated Hospital of Shantou University Medical College, China.
Abstract
Background: Osteoarthritis (OA) involves progressive cartilage degeneration, while conventional white-light arthroscopy mainly provides surface morphological information and lacks quantitative functional contrast. Multimodal photoacoustic arthroscopy (MMPA) may strengthen intraoperative cartilage assessment by enabling earlier identification of matrix, collagen, and biomechanical alterations that are not readily visible under white light. Methods: We developed a preclinical multimodal photoacoustic arthroscopy (MMPA) prototype integrating photoacoustic imaging, polarization-resolved photoacoustic imaging, and photoacoustic elasticity imaging to enable label-free, in situ microscopic-resolution assessment of cartilage composition, collagen-related structural anisotropy, and biomechanical response. Validation was performed on 300 human cartilage regions spanning multiple degenerative grades. A feature-based machine-learning classifier was developed mainly using cartilage regions with Mankin scores from 2 to 9, and an independent external validation cohort including 120 cartilage regions was used to assess model generalizability. Longitudinal in vivo monitoring was conducted in a large-animal model. MRI and white-light arthroscopy were used as comparative imaging modalities, whereas histopathological grading served as the reference standard. Results: MMPA provided additional visualization of microscopic morphomechanical changes that were less apparent on conventional white-light arthroscopy. The multimodal machine-learning model achieved AUCs of 0.93 (95% CI: 0.91–0.95) internally and 0.89 (95% CI: 0.87–0.90) externally. MMPA detected 81% of lesions, compared with 78% for MRI and 72% for white-light arthroscopy, with a significant overall difference (Cochran's Q = 21.00 , p = 2.75 × 10 − 5 ) and significant pairwise differences (MMPA vs MRI, p = 0.0313 ; MMPA vs white-light arthroscopy, p = 0.000831 ). MMPA-derived scores most closely tracked histopathological severity. Conclusion: This study establishes a preclinical multimodal photoacoustic arthroscopy framework for quantitative intraoperative morphomechanical assessment of articular cartilage degeneration. MMPA has potential to serve as a quantitative upgrade to conventional white-light arthroscopy, assisting surgeons in earlier recognition of degenerative cartilage changes from Mankin score 2 onward, lesion evaluation, and intraoperative decision-making. The translational potential of this article : This study presents a preclinical multimodal photoacoustic arthroscopy platform that provides quantitative intraoperative assessment of cartilage composition, structural anisotropy, and biomechanical properties. Rather than replacing MRI, MMPA is intended to complement preoperative MRI by offering real-time functional assessment during arthroscopy.
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BibTeX
@article{li2026multimodal,
title = {{Multimodal photoacoustic arthroscopy for quantitative morphomechanical assessment of articular cartilage}},
author = {Ruihuan Li and Haishu Xin and Fanjia Zeng and Wei Chen and Xiaojia Zheng and Hongjiang Chen and Zebin Ma and Erqi Wang and Hao Gao and Tao Shen and Ting Guo and Chaoyue He and Jiankun Xu and ZhenHui Zhang and Jun Hu},
journal = {Journal of Orthopaedic Translation},
year = {2026},
month = oct,
doi = {10.1016/j.jot.2026.101253},
url = {https://doi.org/10.1016/j.jot.2026.101253},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Multimodal photoacoustic arthroscopy for quantitative morphomechanical assessment of articular cartilage
AU - Ruihuan Li
AU - Haishu Xin
AU - Fanjia Zeng
AU - Wei Chen
AU - Xiaojia Zheng
AU - Hongjiang Chen
AU - Zebin Ma
AU - Erqi Wang
AU - Hao Gao
AU - Tao Shen
AU - Ting Guo
AU - Chaoyue He
AU - Jiankun Xu
AU - ZhenHui Zhang
AU - Jun Hu
PY - 2026
DA - 2026/10/24
JO - Journal of Orthopaedic Translation
DO - 10.1016/j.jot.2026.101253
UR - https://doi.org/10.1016/j.jot.2026.101253
AB - Background: Osteoarthritis (OA) involves progressive cartilage degeneration, while conventional white-light arthroscopy mainly provides surface morphological information and lacks quantitative functional contrast. Multimodal photoacoustic arthroscopy (MMPA) may strengthen intraoperative cartilage assessment by enabling earlier identification of matrix, collagen, and biomechanical alterations that are not readily visible under white light. Methods: We developed a preclinical multimodal photoacoustic arthroscopy (MMPA) prototype integrating photoacoustic imaging, polarization-resolved photoacoustic imaging, and photoacoustic elasticity imaging to enable label-free, in situ microscopic-resolution assessment of cartilage composition, collagen-related structural anisotropy, and biomechanical response. Validation was performed on 300 human cartilage regions spanning multiple degenerative grades. A feature-based machine-learning classifier was developed mainly using cartilage regions with Mankin scores from 2 to 9, and an independent external validation cohort including 120 cartilage regions was used to assess model generalizability. Longitudinal in vivo monitoring was conducted in a large-animal model. MRI and white-light arthroscopy were used as comparative imaging modalities, whereas histopathological grading served as the reference standard. Results: MMPA provided additional visualization of microscopic morphomechanical changes that were less apparent on conventional white-light arthroscopy. The multimodal machine-learning model achieved AUCs of 0.93 (95% CI: 0.91–0.95) internally and 0.89 (95% CI: 0.87–0.90) externally. MMPA detected 81% of lesions, compared with 78% for MRI and 72% for white-light arthroscopy, with a significant overall difference (Cochran's Q = 21.00 , p = 2.75 × 10 − 5 ) and significant pairwise differences (MMPA vs MRI, p = 0.0313 ; MMPA vs white-light arthroscopy, p = 0.000831 ). MMPA-derived scores most closely tracked histopathological severity. Conclusion: This study establishes a preclinical multimodal photoacoustic arthroscopy framework for quantitative intraoperative morphomechanical assessment of articular cartilage degeneration. MMPA has potential to serve as a quantitative upgrade to conventional white-light arthroscopy, assisting surgeons in earlier recognition of degenerative cartilage changes from Mankin score 2 onward, lesion evaluation, and intraoperative decision-making. The translational potential of this article : This study presents a preclinical multimodal photoacoustic arthroscopy platform that provides quantitative intraoperative assessment of cartilage composition, structural anisotropy, and biomechanical properties. Rather than replacing MRI, MMPA is intended to complement preoperative MRI by offering real-time functional assessment during arthroscopy.
SN - 2214-031X
SN - 2214-0328
ER -