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Garcia SA, White MS, Gallegos J, Balza I, Kahan S, Palmieri-Smith RM. Associations between Body Mass Index, Gait Mechanics and Trochlear Cartilage Thickness in Those with ACL Reconstruction. Med Sci Sports Exerc 2024; 56:1805-1815. [PMID: 38600643 PMCID: PMC11326996 DOI: 10.1249/mss.0000000000003446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
PURPOSE High body mass index (BMI) is a strong predictor of posttraumatic osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR). Altered gait mechanics are independently affected by BMI and ACLR, and influence OA risk. Yet, evidence directly assessing the impact of high BMI on gait or cartilage characteristics after ACLR are limited. Here, we evaluated if high BMI moderates associations between gait and trochlear cartilage structure in individuals with ACLR. METHODS Treadmill walking biomechanics were evaluated in 40 normal BMI and 24 high BMI participants with ACLR at self-selected speeds. Normalized and absolute peak and cumulative loads (i.e., impulse) were extracted for peak knee flexion and adduction moments (KFM, KAM) and vertical ground reaction force (GRF). Medial and lateral femoral cartilage thickness and medial/lateral thickness ratios were assessed via ultrasound. RESULTS Those with ACLR and high BMI walked with reduced normalized peak vertical GRFs, and greater absolute peak and cumulative loads compared with normal BMI individuals with ACLR. Those with ACLR and high BMI also exhibited thinner cartilage and greater medial/lateral ratios in ACLR limbs compared with contralateral limbs whereas normal BMI individuals with ACLR exhibited thicker ACLR limb cartilage. Lastly, greater peak KAM and KAM cumulative load were associated with thicker lateral cartilage and lesser medial/lateral thickness ratios, but only in the high BMI group. CONCLUSIONS We observed those with high BMI after ACLR exhibited trochlear cartilage structural alterations not observed in normal BMI patients, whereas differential associations between loading outcomes and cartilage thickness in ACLR knees were observed between groups. Those with high BMI after ACLR may require different therapeutic strategies to optimize joint health in this subset of patients.
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Affiliation(s)
- Steven A. Garcia
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL
- Biomechanics and Clinical Outcomes Laboratory, University of Illinois at Chicago, Chicago IL
| | - McKenzie S. White
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY
| | - Jovanna Gallegos
- School of Kinesiology, University of Michigan, Ann Arbor MI
- Orthopaedic Rehabilitation Biomechanics Laboratory, University of Michigan, Ann Arbor MI
| | - Isabella Balza
- School of Kinesiology, University of Michigan, Ann Arbor MI
- Orthopaedic Rehabilitation Biomechanics Laboratory, University of Michigan, Ann Arbor MI
| | - Seth Kahan
- School of Kinesiology, University of Michigan, Ann Arbor MI
- Orthopaedic Rehabilitation Biomechanics Laboratory, University of Michigan, Ann Arbor MI
| | - Riann M. Palmieri-Smith
- School of Kinesiology, University of Michigan, Ann Arbor MI
- Orthopaedic Rehabilitation Biomechanics Laboratory, University of Michigan, Ann Arbor MI
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Argentieri EC, Pekmezian A, Wach A, Zhu A, Bansal S, Breighner RE, Leatherman ER, Potter HG, Maher SA, Koff MF. Baseline-to-loaded changes in regional tibial cartilage thickness, T1ρ and T2: Utilization of an MRI compatible loading device. J Orthop Res 2024. [PMID: 39177306 DOI: 10.1002/jor.25956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/24/2024]
Abstract
The objective of the study was to evaluate tibial cartilage thickness (TCT), T1ρ and T2 values within both loaded and baseline configurations in a cadaveric knee model using a 3D bone based tibial coordinate system. Ten intact cadaveric knees were mounted into an magnetic resonance imaging (MRI) compatible loading device. Morphologic and quantitative MRI (qMRI) images were acquired with the knee in a baseline configuration and after application of 50% body weight. The morphologic images were evaluated for cartilage degeneration using a modified Noyes scoring system. A 3D bone-based tibial coordinate system was utilized to evaluate regional changes of tibial T1ρ, T2, and cartilage thickness values among regions covered and uncovered by the meniscus. Inter-regional differences in medial and lateral MRI outcomes were found between loaded and baseline configurations. Cartilage regions covered by the meniscus demonstrated disparate qMRI and TCT results as compared to cartilage regions not covered by the meniscus. The regions covered by meniscus experienced a ~3.5%, ~0.5%, and ~5.5% reduction of T1ρ (p < 0.05, medial and lateral compartments), T2 and TCT, respectively, in both compartments while regions not covered by the meniscus experienced larger reductions of ~10%, ~2%, and ~10.5% reduction of T1ρ (p < 0.05, medial and lateral compartments), T2 and TCT (p < 0.05, lateral compartment only), respectively, in both compartments. T1ρ and T2 decreases following application of 50% body weight load were substantially larger in the tibial regions with modified Noyes grade 3 (n = 2) compared to either healthy regions (n = 85, p < 0.0.003) or regions with modified Noyes grade 2 (n = 13, p < 0.004). Interregional differences in MRI outcomes reflect variations in structure and function, and largely followed a pattern in cartilage regions that were covered or not covered by the meniscus. Results of the current study suggest that ΔT1ρ and ΔT2 values may be sensitive to superficial fissuring, more than baseline or loaded T1ρ or T2 values, or TCT alone, however future studies with additional specimens, with greater variability in OA grade distribution, may further emphasize the current findings.
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Affiliation(s)
- Erin C Argentieri
- Department of Radiology and Imaging, MRI Laboratory, Hospital for Special Surgery, New York City, New York, USA
| | - Ashley Pekmezian
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York, USA
| | - Arden Wach
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York, USA
| | - Andrew Zhu
- Weill Cornell Medicine, Weill Cornell Medical College, New York City, New York, USA
| | - Sonia Bansal
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York, USA
| | - Ryan E Breighner
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York, USA
| | - Erin R Leatherman
- Department of Mathematics and Statistics, Kenyon College, Gambier, Ohio, USA
| | - Hollis G Potter
- Department of Radiology and Imaging, MRI Laboratory, Hospital for Special Surgery, New York City, New York, USA
| | - Suzanne A Maher
- Department of Biomechanics, Hospital for Special Surgery, New York City, New York, USA
| | - Matthew F Koff
- Department of Radiology and Imaging, MRI Laboratory, Hospital for Special Surgery, New York City, New York, USA
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Herger S, Wirth W, Eckstein F, Nüesch C, Egloff C, Mündermann A. Anterior cruciate ligament injury and age affect knee cartilage T2 but not thickness. Osteoarthritis Cartilage 2024:S1063-4584(24)01269-X. [PMID: 38950877 DOI: 10.1016/j.joca.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE To investigate the effect of unilateral anterior cruciate ligament (ACL) injury on cartilage thickness and composition, specifically laminar transverse relaxation time (T2) by magnetic resonance imaging (MRI), in younger and older participants and to compare within-person side differences in these parameters between ACL-injured and healthy controls. DESIGN Quantitative double-echo steady-state 3 Tesla MRI-sequences were acquired in both knees of 85 participants in four groups: 20-30 years: healthy, HEA20-30, n = 24; ACL-injured, ACL20-30, n = 23; 40-60 years: healthy, HEA40-60, n = 24; ACL-injured, ACL40-60, n = 14 (ACL injury 2-10 years prior to study inclusion). Weight-bearing femorotibial cartilages were manually segmented; cartilage T2 and thickness were computed using custom software. Mean and side differences in subregional cartilage thickness, superficial and deep cartilage T2 were compared within and between groups using non-parametric statistics. RESULTS Cartilage thickness did not differ within or between groups. Only the side difference in medial femorotibial cartilage thickness was greater in ACL20-30 than in HEA20-30. Deep zone T2 was longer in the ACL-injured than in the contralateral uninjured knees and than in healthy controls, especially in the lateral compartment. Most ACL-injured participants had side differences in femorotibial deep zone T2 above the threshold derived from controls. CONCLUSION In the ACL-injured knee, early compositional differences in femorotibial cartilage (T2) appear to occur in the deep zone and precede cartilage thickness loss. These results suggest that monitoring laminar T2 after ACL injury may be useful in diagnosing and monitoring early articular cartilage changes.
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Affiliation(s)
- Simon Herger
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Wolfgang Wirth
- Research Program for Musculoskeletal Imaging, Center of Anatomy and Cell Biology, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Felix Eckstein
- Research Program for Musculoskeletal Imaging, Center of Anatomy and Cell Biology, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation (LBIAR), Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - Corina Nüesch
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
| | - Christian Egloff
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland.
| | - Annegret Mündermann
- Department of Orthopedics and Traumatology, University Hospital Basel, Basel Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland.
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Kaneguchi A, Kanehara M, Yamaoka K, Umehara T, Ozawa J. Effects of sex differences on osteoarthritic changes after anterior cruciate ligament reconstruction in rats. Acta Histochem 2024; 126:152172. [PMID: 38943867 DOI: 10.1016/j.acthis.2024.152172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
The prevalence of primary osteoarthritis is higher in females than males. However, it remains unclear if there are sex differences in the incidence of post-traumatic osteoarthritis after anterior cruciate ligament (ACL) reconstruction. In this study, we aimed to investigate the effects of sex on osteoarthritic changes after ACL reconstruction using an animal model. Rats were divided into the following four groups: male control, male ACL reconstruction, female control, and female ACL reconstruction. ACL reconstruction surgery was performed on the right knees of rats in the ACL reconstruction groups, while rats in the control groups did not undergo knee surgery. At 1, 4, and 12 weeks after surgery, cartilage degeneration in the medial tibial plateau and osteophyte formation in the proximal tibia were histologically assessed. After ACL reconstruction, an increase in the Mankin score, cartilage fissures, and osteophyte formation were detected within 12 weeks in both male and female rats, with similar degrees of these changes between males and females. However, changes in cartilage thickness and chondrocyte density after ACL reconstruction differed between males and females. Cartilage thickening was observed in male rats but not in female rats. The increase in chondrocyte density in the anterior region was detected in both males and females but was more pronounced in female rats. In conclusion, osteoarthritic changes were observed after ACL reconstruction in both male and female rats, but differences in changes in cartilage thickness and chondrocyte density were observed between males and females.
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Affiliation(s)
- Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan.
| | - Marina Kanehara
- Major in Medical Engineering and Technology, Graduate School of Medical Technology and Health Welfare Sciences, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Kaoru Yamaoka
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Takuya Umehara
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
| | - Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Kurose-Gakuendai 555-36, Higashi-Hiroshima, Hiroshima, Japan
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Pamukoff DN, Holmes SC, Heredia CE, Shumski EJ, Garcia SA, Montgomery MM. Cartilage deformation following a walking bout in individuals with anterior cruciate ligament reconstruction. J Orthop Res 2024; 42:349-359. [PMID: 37772457 DOI: 10.1002/jor.25694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/16/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023]
Abstract
The purpose was to (1) compare the effect of a walking bout on femoral cartilage deformation between limbs with and without anterior cruciate ligament reconstruction (ACLR) and (2) examine the association between gait kinetics and the magnitude of cartilage deformation. A total of 30 individuals with primary unilateral ACLR completed this study [14 male, 16 female; age = 22.57 (3.78) years; body mass index (BMI) = 25.88 (5.68) kg/m2 ; time since ACLR = 61.00 (16.43) months]. Overground walking biomechanics were assessed on day 1, and a 30-min walking bout or 30-min resting bout (control) were completed on days 2 and 3 (counterbalanced order). Femoral cartilage thickness was measured using ultrasound before, immediately following, and 30-min following each intervention. Linear mixed effects models compared the effect of walking on cartilage thickness between the ACLR and contralateral limbs after adjusting for sex, BMI, speed, and the number of steps. Stepwise regression examined the association between the external knee flexion and adduction moments and cartilage deformation following walking. There was a significant limb × time interaction for medial cartilage thickness. Post hoc analyses indicated that cartilage thickness decreased immediately following walking in the contralateral but not ACLR limb. Main effects of limb were observed for medial, central, and lateral cartilage thickness indicating thicker cartilage in the ACLR compared with contralateral limb. A higher knee adduction moment was associated with greater cartilage deformation in the ACLR limb. Femoral cartilage in the ACLR limb exhibited a less dynamic response to walking than the uninvolved limb, which may be due to habitual underloading during gait.
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Affiliation(s)
- Derek N Pamukoff
- School of Kinesiology, Western University, London, Ontario, Canada
| | - Skylar C Holmes
- Department of Kinesiology, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | | | - Eric J Shumski
- Department of Kinesiology, University of Georgia, Athens, Georgia, USA
| | - Steven A Garcia
- School of Kinesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Melissa M Montgomery
- Department of Kinesiology, California State University, Fullerton, Fullerton, California, USA
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Hori M, Terada M, Suga T, Isaka T. The effect of attending rehabilitation after traumatic knee joint injury on femoral articular cartilage morphology in collegiate rugby players with a history of intracapsular knee joint injury during two-year consecutive rugby seasons. Front Sports Act Living 2024; 5:1309938. [PMID: 38274032 PMCID: PMC10808301 DOI: 10.3389/fspor.2023.1309938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction This present study aimed to compare ultrasonographic measures of femoral articular cartilage during two-year seasons between collegiate rugby players who have attended supervised rehabilitation following intracapsular knee joint injury and those without a history of knee injury. Methods Using a prospective observational study design, 12 male collegiate rugby players with a previous history of intracapsular knee joint injury who have received and completed supervised rehabilitation following their injury and 44 players without knee joint injury participated in this study. Ultrasonographic images were used to verify changes in femoral articular cartilage thickness and cross-sectional area (CSA) with or without a previous history of knee joint injury over two consecutive rugby seasons. Results Significant time main effects were observed for the lateral condylar thickness (p < 0.001), the intercondylar thickness (p = 0.001), the medial condylar thickness (p < 0.001), and CSA (p < 0.001). No significant interactions nor group main effects were identified for all femoral articular cartilage (p < 0.05). Conclusions Collegiate rugby players demonstrated a decrease in femoral articular cartilage thickness and CSA over two-year consecutive rugby seasons. These findings indicate that engaging in collegiate rugby induces alterations in femoral articular cartilage structure. Furthermore, there were no differences in all femoral cartilage outcome measures between rugby players with and without a previous history of traumatic knee joint injury. Therefore, attending supervised rehabilitation at the time of their knee joint injury appeared to reduce the impact of a previous history of intracapsular knee joint injury on the change in femoral articular cartilage thickness and CSA among active rugby players.
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Affiliation(s)
- Miyuki Hori
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Masafumi Terada
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
| | - Tadashi Suga
- Research Organization of Science and Technology, Ritsumeikan University, Kusatsu, Japan
| | - Tadao Isaka
- Faculty of Sport and Health Science, Ritsumeikan University, Kusatsu, Japan
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Murakami R, Taketomi S, Yamagami R, Kono K, Kawaguchi K, Kage T, Arakawa T, Inui H, Tanaka S. Postoperative quadriceps weakness and male sex are risk factors for patellofemoral articular cartilage lesions after anatomical anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2023; 31:5681-5689. [PMID: 37884728 PMCID: PMC10719126 DOI: 10.1007/s00167-023-07633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE Patellofemoral (PF) compartment cartilage lesions are a frequent problem after anterior cruciate ligament (ACL) reconstruction. This study aimed to determine the factors that influence PF cartilage lesions after anatomical ACL reconstruction. METHODS This study enrolled a total of 114 patients who did not manifest PF compartment cartilage lesions during anatomical ACL reconstruction and underwent second-look arthroscopy 18 months postoperatively. Arthroscopy using the International Cartilage Repair Society (ICRS) classification was used to assess cartilage lesions. The correlation between surgical findings, radiographic factors, and clinical factors and change of ICRS grade was analysed. Multivariate regression analysis was conducted to reveal the independent risk factors for PF cartilage lesions among patients' demographic data and parameters that correlated with the change of ICRS grade in the correlation analyses. RESULTS ICRS grade changes in PF cartilage were significantly correlated with age, sex, quadriceps strength at 1 year postoperatively, hamstrings strength at pre- and 1 year postoperatively, and single leg hop test at 1 year postoperatively. However, no significant correlation was found between the time between injury and surgery, posterior tibial slope angle, pre- and postoperative Tegner activity scale, graft type, initial graft tension, meniscus injury, meniscus injury treatment, pre- and postoperative range of motion, anteroposterior laxity and preoperative quadriceps strength, and the change in ICRS grade. Multivariate regression analysis revealed male (P = 0.019) and quadriceps strength weakness at 1 year postoperatively (P = 0.009) as independent risk factors for PF cartilage lesions. CONCLUSIONS Quadriceps strength weakness 1 year after ACL reconstruction and males were correlated with a new PF cartilage lesion after anatomical ACL reconstruction, with no significant correlation between bone-patellar tendon-bone autograft, initial graft tension, or extension deficit and new PF cartilage lesion. Rehabilitation that focuses on quadriceps strength after ACL reconstruction is recommended to prevent new PF cartilage lesions. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ryo Murakami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
| | - Ryota Yamagami
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kenichi Kono
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kohei Kawaguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Tomofumi Kage
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Takahiro Arakawa
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
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Armitano-Lago C, Davis-Wilson HC, Evans-Pickett A, Lisee C, Kershner CE, Blackburn T, Franz JR, Kiefer AW, Nissman D, Pietrosimone B. Gait Variability Structure Linked to Worse Cartilage Composition Post-ACL Reconstruction. Med Sci Sports Exerc 2023; 55:1499-1506. [PMID: 36940200 PMCID: PMC10363223 DOI: 10.1249/mss.0000000000003174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Aberrant gait variability has been observed after anterior cruciate ligament reconstruction (ACLR), yet it remains unknown if gait variability is associated with early changes in cartilage composition linked to osteoarthritis development. Our purpose was to determine the association between femoral articular cartilage T1ρ magnetic resonance imaging relaxation times and gait variability. METHODS T1ρ magnetic resonance imaging and gait kinematics were collected in 22 ACLR participants (13 women; 21 ± 4 yr old; 7.52 ± 1.43 months post-ACLR). Femoral articular cartilage from the ACLR and uninjured limbs were segmented into anterior, central, and posterior regions from the weight-bearing portions of the medial and lateral condyles. Mean T1ρ relaxation times were extracted from each region and interlimb ratios (ILR) were calculated (i.e., ACLR/uninjured limb). Greater T1ρ ILR values were interpreted as less proteoglycan density (worse cartilage composition) in the injured limb compared with the uninjured limb. Knee kinematics were collected at a self-selected comfortable walking speed on a treadmill with an eight-camera three-dimensional motion capture system. Frontal and sagittal plane kinematics were extracted, and sample entropy was used to calculate kinematic variability structure (KV structure ). Pearson's product-moment correlations were conducted to determine the associations between T1ρ and KV structure variables. RESULTS Lesser frontal plane KV structure was associated with greater mean T1ρ ILR in the anterior lateral ( r = - 0.44, P = 0.04) and anterior medial condyles ( r = - 0.47, P = 0 .03). Lesser sagittal plane KV structure was associated with greater mean T1ρ ILR in the anterior lateral condyle ( r = - 0.47, P = 0.03). CONCLUSIONS The association between less KV structure and worse femoral articular cartilage proteoglycan density suggests a link between less variable knee kinematics and deleterious changes joint tissue changes. The findings suggest that less knee kinematic variability structure is a mechanism linking aberrant gait to early osteoarthritis development.
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Affiliation(s)
- Cortney Armitano-Lago
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Hope C. Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Alyssa Evans-Pickett
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Caroline Lisee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Cassidy E. Kershner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Troy Blackburn
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Adam W. Kiefer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Daniel Nissman
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Xie D, Tanaka M, Pedoia V, Li AK, Facchetti L, Neumann J, Lartey R, Souza RB, Link TM, Ma CB, Li X. Baseline cartilage T1ρ and T2 predicted patellofemoral joint cartilage lesion progression and patient-reported outcomes after ACL reconstruction. J Orthop Res 2023; 41:1310-1319. [PMID: 36268873 PMCID: PMC10413330 DOI: 10.1002/jor.25473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/25/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
This study aims to determine if baseline T1ρ and T2 will predict cartilage morphological lesion progression in the patellofemoral joint (PFJ) and patient-reported outcomes at 2-year after anterior cruciate ligament (ACL) reconstruction (ACLR). Thirty-nine ACL-injured patients were studied at baseline and two-year after ACLR. 3 T MR T1ρ and T2 images and Knee Injury and Osteoarthritis Outcome Score (KOOS) were acquired at both time points. Voxel-based relaxometry (VBR) technique was used to detect local cartilage abnormalities. Patients were divided into progression and non-progression groups based on changes of the whole-organ magnetic resonance imaging scoring (WORMS) grading of cartilage in PFJ from baseline to 2-year, and into lower (more pain) and higher (less pain) KOOS pain groups based on 2-year KOOS pain scores, separately. Voxel-based analyses of covariance were used to compare T1ρ and T2 values at baseline between the defined groups. Using VBR analysis, the progression group at 2-year showed higher T1ρ and T2 compared with the non-progression group at baseline, with the medial femoral condyle showing the largest areas with significant differences. At two-year, 56% of patients were able to recover with respect to KOOS pain. The lower KOOS pain group at 2-year showed significantly elevated T1ρ and T2 in the patella at baseline compared with the higher KOOS pain group. In conclusion, baseline T1ρ and T2 mapping, combined with VBR analysis, may help identify ACLR patients at high risk of developing progressive PFJ cartilage lesions and worse clinical symptoms 2-year after surgery.
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Affiliation(s)
- Dongxing Xie
- Program of Advanced Musculoskeletal Imaging, Department of
Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland,
Ohio, USA
- Department of Orthopaedics, Xiangya Hospital, Central South
University, Changsha, Hunan, China
| | - Matthew Tanaka
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Alan K. Li
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Luca Facchetti
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - Richard Lartey
- Program of Advanced Musculoskeletal Imaging, Department of
Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland,
Ohio, USA
| | - Richard B. Souza
- Department of Physical Therapy and Rehabilitation Science,
University of California, San Francisco, San Francisco, California, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University
of California, San Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopaedic Surgery, University of
California, San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Program of Advanced Musculoskeletal Imaging, Department of
Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland,
Ohio, USA
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10
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Beynnon BD, Tourville TW, Hollenbach HC, Shultz S, Vacek P. Intrinsic Risk Factors for First-Time Noncontact ACL Injury: A Prospective Study of College and High School Athletes. Sports Health 2023; 15:433-442. [PMID: 36154754 PMCID: PMC10170220 DOI: 10.1177/19417381221121136] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A comprehensive understanding of the intrinsic risk factors for anterior cruciate ligament (ACL) disruption is important for identifying individuals at increased risk for suffering this trauma and developing interventions to mitigate risk. HYPOTHESIS A variety of risk factors predispose athletes to first-time, noncontact ACL injury and some of these differ between male and female athletes. STUDY DESIGN Prospective cohort study with nested case-control sampling. LEVEL OF EVIDENCE Level 2. METHODS Sport teams at 28 high schools and 8 colleges were monitored prospectively over 4 years, and 109 of 130 athletes who suffered their first noncontact ACL injury participated in the study. At the time of injury, matched control subjects were randomly selected from among the case's teammates and a total of 227 athletes participated. Demographic characteristics, joint laxity, lower extremity alignment, strength, and personality characteristics were measured. The association of each risk factor with injury risk was assessed by conditional logistic regression. RESULTS The risk factors that were associated with ACL injury in both male and female athletes included having a parent with prior ACL injury and increases of the following variables: body weight, anterior displacement of the tibia relative to the femur, genu recurvatum, and generalized joint laxity. Risk factors that are unique to female athletes included increased body mass index, increased trunk flexion strength, and prior non-ACL knee injury. The risk factors specific to male athletes were decreased standing quadriceps angle, decreased hip adduction strength, and chronic disease. CONCLUSION A diverse set of risk factors predispose both male and female athletes to ACL injury, whereas others appear to be sex-specific. CLINICAL RELEVANCE Different approaches for assessing risk and preventing ACL injury are needed for male and female athletes. In addition, personalized prevention strategies may be needed to target the specific characteristics that place an individual at increased risk of suffering this trauma.
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Affiliation(s)
- Bruce D. Beynnon
- Department of Orthopedics and
Rehabilitation, Robert Larner College of Medicine, University of Vermont,
Burlington, Vermont
- Department of Electrical and Biomedical
Engineering, University of Vermont, Burlington, Vermont
| | - Timothy W. Tourville
- Department of Orthopedics and
Rehabilitation, Robert Larner College of Medicine, University of Vermont,
Burlington, Vermont
- Department of Rehabilitation and
Movement Science, College of Nursing and Health Sciences, University of Vermont,
Burlington, Vermont
| | - Helen C. Hollenbach
- Department of Orthopedics and
Rehabilitation, Robert Larner College of Medicine, University of Vermont,
Burlington, Vermont
| | - Sandy Shultz
- Department of Kinesiology, School of
Health and Human Sciences, University of North Carolina at Greensboro, Greensboro,
North Carolina
| | - Pamela Vacek
- Department of Medical Biostatistics,
Robert Larner College of Medicine, University of Vermont, Burlington, Vermont
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11
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Pinette MP, Molino J, Proffen BL, Murray MM, Fleming BC. Effects of Male and Female Sex on the Development of Posttraumatic Osteoarthritis in the Porcine Knee After Anterior Cruciate Ligament Surgery. Am J Sports Med 2022; 50:2417-2423. [PMID: 35722806 PMCID: PMC9473678 DOI: 10.1177/03635465221102118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) is a common sequela of anterior cruciate ligament (ACL) injury, even when surgical treatment is selected. The effect of patient sex on cartilage health after ACL injury and surgical treatment has been less studied. PURPOSE/HYPOTHESIS The study objective was to compare the macroscopic cartilage damage that develops after ACL surgery in male and female Yucatan minipigs. It was hypothesized that after ACL surgery, the macroscopic cartilage damage of the tibiofemoral joints from female animals would be greater than that from male animals. Additionally, it was hypothesized that the effect of sex on the macroscopic cartilage damage would depend on surgical treatment. STUDY DESIGN Controlled laboratory study. METHODS Twelve-month follow-up data were obtained for 55 adolescent Yucatan minipigs (22 female/33 male) that were randomized to 1 of 3 experimental groups: no treatment (ACL transection [ACLT]), ACL reconstruction, and bridge-enhanced ACL restoration. The Osteoarthritis Research Society International guidelines were used to determine a standardized macroscopic cartilage damage score on 5 surfaces of the knee joint. RESULTS Females had significantly worse mean total macroscopic cartilage damage scores on the surgical side (adjusted P value [P adj] = .04) and significantly better scores on the contralateral side (P adj = .01) when compared with males. The trochlear damage scores were also significantly worse in females for surgical limbs (P adj = .009) and significantly better for the contralateral limbs (P adj < .001) when compared with males. Although there were no significant differences in total macroscopic cartilage damage scores between sexes within treatment groups on the surgical limbs (ACLT, P adj = 0.45; ACL reconstruction, P adj = .56; bridge-enhanced ACL restoration, P adj = .23), the mean trochlear scores on the surgical limb of females were significantly worse than those of the males in the ACLT group (P adj = .003). CONCLUSION Mean total macroscopic cartilage damage scores of Yucatan minipigs were significantly worse in females than males, regardless of treatment. These differences were predominantly found in the trochlear scores across all treatment groups. CLINICAL RELEVANCE These data suggest that patient sex could be more influential in the progression of PTOA than surgical treatment after ACL injury. Identifying factors responsible for this discrepancy may prove valuable to identify targets to slow PTOA progression in male and female ACL-injured populations.
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Affiliation(s)
- Megan P. Pinette
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Benedikt L. Proffen
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
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12
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Snyder-Mackler L, Queen RM. ACL special issue, editors. J Orthop Res 2022; 40:7-9. [PMID: 34811792 DOI: 10.1002/jor.25220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Lynn Snyder-Mackler
- Physical Therapy & Biomedical Engineering University of Delaware, Newark, Delaware, USA
| | - Robin M Queen
- Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia, USA
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