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Static images were displayed with software supplied by the magnet manufacturer. Cine MRI images were loaded as imaging sequences into ImageJ software [47] for further analysis. Within this software, images prior to the start of distraction and after the cessation of distraction were deleted from the imaging sequence. The remaining image sequence was then converted into binary images using default threshold settings within Image J. The space between the joint surfaces was then measured prior to joint distraction, immediately after the cracking event (the frame immediately following rapid joint separation) and once distraction forces were ceased. Measurement of joint space separation was performed by a custom Image J script that converted the images in the cine sequence to a binary format. In each cine frame, joint edges were detected automatically through thresholding and the total space between joint surfaces measured within a defined region of interest. In addition, MRI signal intensity was evaluated as a function of time in the region of interest where cavity formation occurred as well as in control areas where signal intensity was not expected to change (i.e. cancellous bone). All images were reviewed by an imaging physicist and two certified radiologists using native contrast settings.

While our work provides new insights into defining the mechanism underlying joint cracking, this new visualization technique opens novel avenues for investigation. Specifically, cine MRI revealed a new phenomenon preceding joint cracking; a transient bright signal in the intra-articular space. While not likely visualized gas given the imaging parameters employed, we do not have direct evidence to explain this observation. We speculate this phenomenon may be related to changes in fluid organization between cartilaginous joint surfaces and specifically may result from evacuation of fluid out of the joint cartilage with increasing tension. If so, this sign may be indicative of cartilage health and therefore provide a non-invasive means of characterizing joint status.

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