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Hollis B, Chatzigeorgiou C, Southam L, Hatzikotoulas K, Kluzek S, Williams A, Zeggini E, Jostins-Dean L, Watt FE. Lifetime risk and genetic predisposition to post-traumatic OA of the knee in the UK Biobank. Osteoarthritis Cartilage 2023; 31:1377-1387. [PMID: 37247657 DOI: 10.1016/j.joca.2023.05.012] [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: 01/10/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Acute knee injury is associated with post-traumatic OA (PTOA). Very little is known about the genome-wide associations of PTOA when compared with idiopathic OA (iOA). Our objective was to describe the development of knee OA after a knee injury and its genetic associations in UK Biobank (UKB). DESIGN Clinically significant structural knee injuries in those ≤50 years were identified from electronic health records and self-reported data in 502,409 UKB participants. Time-to-first knee osteoarthritis (OA) code was compared in injured cases and age-/sex-matched non-injured controls using Cox Proportional Hazards models. A time-to-OA genome-wide association study (GWAS) sought evidence for PTOA risk variants 6 months to 20 years following injury. Evidence for associations of two iOA polygenic risk scores (PRS) was sought. RESULTS Of 4233 knee injury cases, 1896 (44.8%) were female (mean age at injury 34.1 years [SD 10.4]). Over a median of 30.2 (IQR 19.5-45.4) years, 1096 (25.9%) of injured cases developed knee OA. The overall hazards ratio (HR) for knee OA after injury was 1.81 (1.70,1.93), P = 8.9 × 10-74. Female sex and increasing age at injury were associated with knee OA following injury (HR 1.15 [1.02,1.30];1.07 [1,07,1.07] respectively). OA risk was highest in the first 5 years after injury (HR 3.26 [2.67,3.98]), persisting for 40 years. In 3074 knee injury cases included in the time-to-OA GWAS, no variants reached genome-wide significance. iOA PRS was not associated with time-to-OA (HR 0.43 [0.02,8.41]). CONCLUSIONS Increasing age at injury and female sex appear to be associated with future development of PTOA in UKB, the risk of which was greatest in the 5 years after injury. Further international efforts towards a better-powered meta-analysis will definitively elucidate genetic similarities and differences of PTOA and iOA.
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Affiliation(s)
- B Hollis
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - C Chatzigeorgiou
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - L Southam
- Institute of Translational Genomics, Helmholtz, Munich, Germany
| | - K Hatzikotoulas
- Institute of Translational Genomics, Helmholtz, Munich, Germany
| | - S Kluzek
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, United Kingdom
| | | | - E Zeggini
- Institute of Translational Genomics, Helmholtz, Munich, Germany
| | - L Jostins-Dean
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom
| | - F E Watt
- Department of Immunology and Inflammation, Imperial College London, London, United Kingdom; Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, United Kingdom.
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O'Sullivan O, Ladlow P, Steiner K, Kuyser D, Ali O, Stocks J, Valdes AM, Bennett AN, Kluzek S. Knee MRI biomarkers associated with structural, functional and symptomatic changes at least a year from ACL injury - A systematic review. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100385. [PMID: 37547184 PMCID: PMC10400916 DOI: 10.1016/j.ocarto.2023.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/11/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Osteoarthritis (OA) results from various aetiologies, including joint morphology, biomechanics, inflammation, and injury. The latter is implicated in post-traumatic OA, which offers a paradigm to identify potential biomarkers enabling early identification and intervention. This review aims to describe imaging features associated with structural changes or symptoms at least one year following injury. Methodology A systematic review was conducted using PRISMA guidance, prospectively registered on PROSPERO (CRD42022371838). Three independent reviewers screened titles and abstracts, followed by full-texts, performed data extraction, and risk of bias assessments (Newcastle-Ottawa Scale). Inclusion criteria included imaging studies involving human participants aged 18-45 who had sustained a significant knee injury at least a year previously. A narrative synthesis was performed using synthesis without meta-analysis methodology. Results Six electronic databases and conference proceedings were searched, identifying 11 studies involving 776 participants. All studies included participants suffering an anterior cruciate ligament (ACL) injury and utilised MRI. Different, and not directly comparable, techniques were used. MRI features could be broadly divided into structural, including joint position and morphology, and compositional. Promising biomarkers for diagnosing and predicting osteoarthritis include T1rho and T2 relaxation time techniques, bone morphology changes and radiomic modelling. Discussion As early as 12 months after injury, differences in tibia position, bone morphology, presence of effusion and synovitis, and cartilage/subchondral bone composition can be detected, some of which are linked with worse patient-reported or radiological progression. Standardisation, including MR strength, position, sequence, scoring and comparators, is required to utilise clinical and research OA imaging biomarkers fully.
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Affiliation(s)
- Oliver O'Sullivan
- Academic Unit of Injury, Recovery and Inflammation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
| | - Peter Ladlow
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK
- Department of Health, University of Bath, Bath, UK
| | - Kat Steiner
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | | | | | - Joanne Stocks
- Academic Unit of Injury, Recovery and Inflammation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Ana M. Valdes
- Nottingham NIHR Biomedical Research Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | | | - Stefan Kluzek
- Academic Unit of Injury, Recovery and Inflammation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
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Wang X, Bennell KL, Wang Y, Fortin K, Saxby DJ, Killen BA, Wrigley TV, Cicuttini FM, Van Ginckel A, Lloyd DG, Feller JA, Vertullo CJ, Whitehead T, Gallie P, Bryant AL. Patellar cartilage increase following ACL reconstruction with and without meniscal pathology: a two-year prospective MRI morphological study. BMC Musculoskelet Disord 2021; 22:909. [PMID: 34711188 PMCID: PMC8555213 DOI: 10.1186/s12891-021-04794-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Anterior cruciate ligament reconstruction (ACLR) together with concomitant meniscal injury are risk factors for the development of tibiofemoral (TF) osteoarthritis (OA), but the potential effect on the patellofemoral (PF) joint is unclear. The aim of this study was to: (i) investigate change in patellar cartilage morphology in individuals 2.5 to 4.5 years after ACLR with or without concomitant meniscal pathology and in healthy controls, and (ii) examine the association between baseline patellar cartilage defects and patellar cartilage volume change. Methods Thirty two isolated ACLR participants, 25 ACLR participants with combined meniscal pathology and nine healthy controls underwent knee magnetic resonance imaging (MRI) with 2-year intervals (baseline = 2.5 years post-ACLR). Patellar cartilage volume and cartilage defects were assessed from MRI using validated methods. Results Both ACLR groups showed patellar cartilage volume increased over 2 years (p < 0.05), and isolated ACLR group had greater annual percentage cartilage volume increase compared with controls (mean difference 3.6, 95% confidence interval (CI) 1.0, 6.3%, p = 0.008) and combined ACLR group (mean difference 2.2, 95% CI 0.2, 4.2%, p = 0.028). Patellar cartilage defects regressed in the isolated ACLR group over 2 years (p = 0.02; Z = − 2.33; r = 0.3). Baseline patellar cartilage defect score was positively associated with annual percentage cartilage volume increase (Regression coefficient B = 0.014; 95% CI 0.001, 0.027; p = 0.03) in the pooled ACLR participants. Conclusions Hypertrophic response was evident in the patellar cartilage of ACLR participants with and without meniscal pathology. Surprisingly, the increase in patellar cartilage volume was more pronounced in those with isolated ACLR. Although cartilage defects stabilised in the majority of ACLR participants, the severity of patellar cartilage defects at baseline influenced the magnitude of the cartilage hypertrophic response over the subsequent ~ 2 years. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04794-5.
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Affiliation(s)
- Xinyang Wang
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton, Victoria, 3010, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton, Victoria, 3010, Australia
| | - Yuanyuan Wang
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karine Fortin
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton, Victoria, 3010, Australia.,Faculty of Arts, Monash University, Melbourne, Victoria, Australia
| | - David J Saxby
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Griffith University Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Gold Coast, Australia
| | - Bryce A Killen
- Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium
| | - Tim V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton, Victoria, 3010, Australia
| | - Flavia M Cicuttini
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ans Van Ginckel
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - David G Lloyd
- School of Allied Health Sciences, Griffith University, Gold Coast, Australia.,Griffith University Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Gold Coast, Australia
| | - Julian A Feller
- OrthoSport Victoria, Melbourne, Australia.,College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Christopher J Vertullo
- Griffith University Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Gold Coast, Australia.,Knee Research Australia, Gold Coast, Australia
| | | | | | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, 161 Barry Street, Carlton, Victoria, 3010, Australia.
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Larson D, Nathan Vannatta C, Rutherford D, Kernozek TW. Kinetic changes associated with extended knee landings following anterior cruciate ligament reconstruction in females. Phys Ther Sport 2021; 52:180-188. [PMID: 34555646 DOI: 10.1016/j.ptsp.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/09/2021] [Accepted: 09/12/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To determine the relationship between knee flexion excursion symmetry and lower extremity kinematics, kinetics, and muscle, joint, and ligament forces in females 1-3 years after ACL reconstruction. DESIGN Cross-sectional. SETTING Laboratory. PARTICIPANTS Twenty-one, college-aged females. MAIN OUTCOME MEASURES Lower extremity kinetics and kinematics, including estimated muscle, tibiofemoral, and ligament forces were assessed using 3D motion analysis and a musculoskeletal modeling approach. Participants demonstrating greater than 10% asymmetry in knee flexion excursion were classified as landing with an "extended knee". Group and between-limb differences were compared. RESULTS Ten participants were classified as landing with an "extended knee" on the involved limb, while eleven exhibited a symmetric landing pattern. Participants landing with an "extended knee" demonstrated reduced knee extension moment and quadriceps force in the involved limb (p < 0.05). CONCLUSIONS These findings indicate that an "extended knee" landing pattern was associated with reduced knee extension moment and quadriceps muscle force in females 1-3 years after ACL reconstruction. This may represent an altered strategy that clinicians may choose to identify and address during rehabilitation.
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Affiliation(s)
- Daniel Larson
- Sports Physical Therapy Department, Gundersen Health System, Onalaska, WI, USA.
| | - C Nathan Vannatta
- Sports Physical Therapy Department, Gundersen Health System, Onalaska, WI, USA; La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Drew Rutherford
- La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, WI, USA; Health Professions Department, University of Wisconsin-La Crosse, La Crosse, WI, USA
| | - Thomas W Kernozek
- La Crosse Institute for Movement Science, University of Wisconsin-La Crosse, La Crosse, WI, USA; Health Professions Department, University of Wisconsin-La Crosse, La Crosse, WI, USA
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Diemer F, Zebisch J, Saueressig T. [Consequences of anterior cruciate ligament rupture: a systematic umbrella review]. SPORTVERLETZUNG-SPORTSCHADEN 2021; 36:18-37. [PMID: 34544171 DOI: 10.1055/a-1474-8986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The treatment of an anterior cruciate ligament rupture is still controversial. In particular, this applies to the question of conservative versus surgical treatment. The answer to this question is often based on consequential damage such as the development of posttraumatic osteoarthritis, secondary damage to the meniscus or cartilage, and participation in sports. If there are significant differences in these parameters between the individual treatment options, the results will be of great importance for the development of evidence-based treatment pathways. Therefore, the aim of this work was to evaluate the development of knee osteoarthritis after rupture of the anterior cruciate ligament and the corresponding treatment (conservative or surgical). MATERIAL AND METHODS To answer the above question, a systematic literature search was conducted in Medline via Pubmed, the Cochrane Library and in CINAHL. Only systematic reviews with a minimum follow-up period of 10 years were included. The search was conducted in January 2020 and updated in January 2021. Investigated cohorts included patients with a rupture of the anterior cruciate ligament who had undergone either conservative or surgical treatment. Osteoarthritis was diagnosed either radiologically (recognized scores) or clinically (pain and impaired function). Appropriate reviews were qualitatively evaluated using the AMSTAR-2 questionnaire. RESULTS The literature research initially identified n = 42 reviews from which 14 reviews were included. After full-text review and qualitative evaluation, only n = 2 systematic reviews remained for evaluation. The results of both papers show imprecise data with a high variability. However, it can be assumed with high probability that the development of osteoarthritis of the knee is increased after a rupture of the anterior cruciate ligament. There is no evidence that the incidence of joint degeneration may be reduced by reconstruction of the anterior cruciate ligament, nor is there a difference when comparing conservative and surgical treatment directly. CONCLUSION Patients with an anterior cruciate ligament rupture are likely to be at a greater risk of developing progressive joint degeneration. A protective effect of cruciate ligament surgery has not been found in the evaluated studies. A general argument in favour of cruciate ligament surgery aiming to achieve a protective effect on hyaline articular cartilage seems obsolete based on the results and should therefore not be used in patient education in the future.
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Affiliation(s)
- Frank Diemer
- DIGOTOR GbR, Brackenheim, Germany.,Physio Meets Science GmbH, Leimen, Germany
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6
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Pedersen M, Grindem H, Berg B, Gunderson R, Engebretsen L, Axe MJ, Snyder-Mackler L, Risberg MA. Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study. Orthop J Sports Med 2021; 9:23259671211027530. [PMID: 34423060 PMCID: PMC8375355 DOI: 10.1177/23259671211027530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices. PURPOSE To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (<6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (>6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&L grade ≥2 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain ≤72. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&L grade ≥2/osteophyte (definite osteophyte without joint space narrowing) and K&L grade ≥1. RESULTS At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&L grade ≥2) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&L grade ≥2/osteophyte and K&L grade ≥1, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups. CONCLUSION There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.
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Affiliation(s)
- Marie Pedersen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Hege Grindem
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Bjørnar Berg
- Orthopedic Clinic, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway
| | | | - Lars Engebretsen
- Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopedic Clinic, Oslo University Hospital, Oslo, Norway
| | - Michael J. Axe
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- First State Orthopaedics, Newark, Delaware, USA
| | - Lynn Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
- Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - May Arna Risberg
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Orthopedic Clinic, Oslo University Hospital, Oslo, Norway
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Roemer FW, Lohmander LS, Englund M, Guermazi A, Åkesson A, Frobell R. Development of MRI-defined Structural Tissue Damage after Anterior Cruciate Ligament Injury over 5 Years: The KANON Study. Radiology 2021; 299:383-393. [PMID: 33687286 DOI: 10.1148/radiol.2021202954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background MRI is used to evaluate structural joint changes after anterior cruciate ligament (ACL) injury, but no long-term data are available for comparing different treatment approaches. Purpose To describe structural joint damage with MRI over a 5-year period in the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) study and to compare frequencies of such tissue damage for a nonsurgical versus a surgical treatment strategy. Materials and Methods In this secondary analysis of a prospective trial (ISRCTN 84752559), 119 participants with an acute ACL injury were evaluated. Participants were enrolled from 2002 through 2006, the 2-year follow-up started in 2008, and the 5-year follow-up started in 2011. A 1.5-T MRI examination was performed at baseline and at 2- and 5-year follow-up. MRI scans were read according to a validated scoring instrument. Kruskal-Wallis tests were used to assess whether the frequencies of structural damage differed between the three as-treated groups. Results Of 119 participants (mean age, 26 years ± 5 [standard deviation]), 91 men were evaluated. At 2- and 5-year follow-up, respectively, 13% (15 of 117) and 13% (15 of 115) of knees showed incident cartilage damage in the medial tibiofemoral joint, 11% (13 of 117) and 17% (20 of 115) of knees showed incident cartilage damage in the lateral tibiofemoral joint, and 4% (five of 117) and 8% (nine of 115) of knees showed incident cartilage damage in the patellofemoral joint. Osteophyte development was seen in 23% (27 of 117) and 29% (33 of 115) of knees in the medial tibiofemoral joint, in 36% (42 of 117) and 43% (49 of 115) of knees in the lateral tibiofemoral joint, and in 35% (41 of 117) and 37% (42 of 115) of knees in the patellofemoral joint. No major differences between the groups were found for incident or worsening cartilage damage, bone marrow lesions, and osteophytes at 2 or 5 years. The rehabilitation-alone group showed less Hoffa-synovitis at 2 (P = .02) and 5 (P = .008) years. Conclusion Young adults with anterior cruciate ligament injury showed no major difference in frequency of structural tissue damage on MRI scans at 2 and 5 years regardless of treatment. However, the rehabilitation-alone group had less inflammation at 2 and 5 years. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Andreisek in this issue.
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Affiliation(s)
- Frank W Roemer
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - L Stefan Lohmander
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Martin Englund
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Ali Guermazi
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Anna Åkesson
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
| | - Richard Frobell
- From the Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany (F.W.R.); Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 4th Floor, 820 Harrison Avenue, Boston, MA 02118 (F.W.R., A.G.); Department of Clinical Sciences Lund, Orthopaedics (F.W.R., L.S.L., R.F.), and Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund (M.E.), Lund University, Lund, Sweden; Department of Radiology, VA Boston Healthcare System, West Roxbury, Mass (A.G.); and Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden (A.Å.)
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Friedman JM, Su F, Zhang AL, Allen CR, Feeley BT, Souza R, Li X, Ma CB, Lansdown DA. Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2021; 49:442-449. [PMID: 33395319 DOI: 10.1177/0363546520980431] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The association between activity level after anterior cruciate ligament (ACL) reconstruction (ACLR) and development of posttraumatic osteoarthritis (PTOA) remains unclear. This study investigated the relationship of patient-reported outcomes and progressive cartilage degenerative changes at 3 years after ACLR. HYPOTHESIS Higher activity levels, as measured by Marx scores, are significantly correlated with early cartilage degeneration after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 35 patients (16 women; mean age, 31.0 ± 7.6 years) with isolated ACLR and without pre-existing arthritis were prospectively enrolled. Patients reported Marx activity scores and Knee injury and Osteoarthritis Outcome Score (KOOS) scores and underwent T1ρ magnetic resonance imaging (MRI) preoperatively, 6 months, 1 year, 2 years, and 3 years after ACLR with soft tissue graft (22 autograft). The change in cartilage relaxation times between preoperative and 3-year imaging was used to identify cartilage degeneration, defined as an increase in T1ρ values by 14.3%. Correlation between Marx activity levels, KOOS scores, and T1ρ degeneration was performed with the Spearman rank test. The Fisher exact test was used to test for association between Marx activity score cutoffs and degeneration. The Student t test was used to compare Whole-Organ Magnetic Resonance Imaging Score (WORMS) and T1ρ relaxation times. Significance was defined as P < .05. RESULTS Sixteen patients (45.7%) showed evidence of cartilage degeneration at 3 years, most frequently in the medial compartment (n = 12; 34%). Higher Marx activity scores at 3 years correlated with cartilage degeneration in the medial femur (rho = 0.34; P = .045), and medial tibia (rho = 0.43; P = .01). A Marx score of 11 or greater at 3 years was significantly associated with medial compartment degeneration (P = .03), with a positive predictive value of 52.6%. No Marx score cutoff at years 1 or 2 predicted future cartilage degeneration. The KOOS Quality of Life score was inversely correlated with cartilage degeneration (rho = 0.38; P = .02). WORMS did not correlate with degeneration of the medial compartment. CONCLUSION Increased activity at 3 years after ACLR was significantly associated with increased risk of medial compartment PTOA. While further research is needed to fully define these relationships, patients may be counseled that return to Marx activity levels of greater than 11 may be associated with a higher risk of medial compartment cartilage degeneration.
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Affiliation(s)
- James M Friedman
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Favian Su
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christina R Allen
- Department of Orthopedic Surgery, Yale University, New Haven, Connecticut, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Richard Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Biomedical Engineering, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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9
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Abstract
PURPOSE OF REVIEW Current thinking in the study of posttraumatic osteoarthritis (PTOA) is overviewed: the osteoarthritis which follows acute joint injury. The review particularly highlights important publications in the last 18 months, also reflecting on key older literature, in terms of what have we have we learned and have yet to learn from PTOA, which can advance the osteoarthritis field as a whole. RECENT FINDINGS PTOA is a mechanically driven disease, giving insight into mechanical drivers for osteoarthritis. A mechanosensitive molecular tissue injury response (which includes activation of pain, degradative and also repair pathways) is triggered by acute joint injury and seen in osteoarthritis. Imaging features of PTOA are highly similar to osteoarthritis, arguing against it being a different phenotype. The inflammatory pathways activated by injury contribute to early joint symptoms. However, later structural changes appear to be dissociated from traditional measures of synovial inflammation. SUMMARY PTOA remains an important niche in which to understand processes underlying osteoarthritis and seek interventional targets. Whether PTOA has true molecular or clinical differences to osteoarthritis as a whole remains to be understood. This knowledge is important for a field where animal modelling of the disease relies heavily on the link between injury and osteoarthritis.
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Affiliation(s)
- Fiona E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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10
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Is good muscle function a protective factor for early signs of knee osteoarthritis after anterior cruciate ligament reconstruction? The SHIELD cohort study protocol. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100102. [DOI: 10.1016/j.ocarto.2020.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 11/18/2022] Open
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11
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Meniscus or Cartilage Injury at the Time of Anterior Cruciate Ligament Tear Is Associated With Worse Prognosis for Patient-Reported Outcome 2 to 10 Years After Anterior Cruciate Ligament Injury: A Systematic Review. J Orthop Sports Phys Ther 2020; 50:490-502. [PMID: 32741324 PMCID: PMC7498413 DOI: 10.2519/jospt.2020.9451] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES (1) To assess prognostic factors for patient-reported outcome measures (PROMs) and physical activity 2 to 10 years after anterior cruciate ligament reconstruction (ACLR) or anterior cruciate ligament (ACL) injury, and (2) to assess differences in prognostic factors between patients treated with ACLR and with rehabilitation alone. DESIGN Prognosis systematic review. LITERATURE SEARCH Systematic searches were performed in PubMed, Web of Science, and SPORTDiscus. STUDY SELECTION CRITERIA We selected prospective cohort studies and randomized clinical trials that included adults or adolescents undergoing either ACLR or rehabilitation alone after ACL rupture. Studies had to assess the statistical association between potential prognostic factors (factors related to patient characteristics, injury, or knee symptoms/function measured at baseline or within 1 year) and outcomes (PROMs and physical activity). DATA SYNTHESIS Our search yielded 997 references. Twenty studies met the inclusion criteria. Seven studies with low or moderate risk of bias remained for data synthesis. RESULTS Moderate-certainty evidence indicated that concomitant meniscus and cartilage injuries were prognostic factors for worse PROMs 2 to 10 years after ACLR. Very low-certainty evidence suggested that body mass index, smoking, and baseline PROMs were prognostic factors for worse outcome. Very low-certainty evidence suggested that female sex and a worse baseline Marx Activity Rating Scale score were prognostic factors for a worse Marx Activity Rating Scale score 2 to 10 years after ACLR. There was a lack of studies on prognostic factors after rehabilitation alone. CONCLUSION Concomitant meniscus and cartilage injuries were prognostic factors for worse long-term PROMs after ACLR. The certainty was very low for other prognostic factors. J Orthop Sports Phys Ther 2020;50(9):490-502. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9451.
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12
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Svantesson E, Hamrin Senorski E, Webster KE, Karlsson J, Diermeier T, Rothrauff BB, Meredith SJ, Rauer T, Irrgang JJ, Spindler KP, Ma CB, Musahl V. Clinical outcomes after anterior cruciate ligament injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group. J ISAKOS 2020. [DOI: 10.1136/jisakos-2020-000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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13
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Svantesson E, Hamrin Senorski E, Webster KE, Karlsson J, Diermeier T, Rothrauff BB, Meredith SJ, Rauer T, Irrgang JJ, Spindler KP, Ma CB, Musahl V, The Panther Symposium Acl Injury Clinical Outcomes Consensus Group, Fu FH, Ayeni OR, Della Villa F, Della Villa S, Dye S, Ferretti M, Getgood A, Järvelä T, Kaeding CC, Kuroda R, Lesniak B, Marx RG, Maletis GB, Pinczewski L, Ranawat A, Reider B, Seil R, van Eck C, Wolf BR, Yung P, Zaffagnini S, Hao Zheng M. Clinical Outcomes After Anterior Cruciate Ligament Injury: Panther Symposium ACL Injury Clinical Outcomes Consensus Group. Orthop J Sports Med 2020; 8:2325967120934751. [PMID: 32754624 PMCID: PMC7378729 DOI: 10.1177/2325967120934751] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/12/2020] [Indexed: 01/16/2023] Open
Abstract
A stringent outcome assessment is a key aspect of establishing evidence-based
clinical guidelines for anterior cruciate ligament (ACL) injury treatment. To
establish a standardized assessment of clinical outcome after ACL treatment, a
consensus meeting including a multidisciplinary group of ACL experts was held at
the ACL Consensus Meeting Panther Symposium, Pittsburgh, Pennsylvania, USA, in
June 2019. The aim was to establish a consensus on what data should be reported
when conducting an ACL outcome study, what specific outcome measurements should
be used, and at what follow-up time those outcomes should be assessed. The group
reached consensus on 9 statements by using a modified Delphi method. In general,
outcomes after ACL treatment can be divided into 4 robust categories: early
adverse events, patient-reported outcomes (PROs), ACL graft failure/recurrent
ligament disruption, and clinical measures of knee function and structure. A
comprehensive assessment after ACL treatment should aim to provide a complete
overview of the treatment result, optimally including the various aspects of
outcome categories. For most research questions, a minimum follow-up of 2 years
with an optimal follow-up rate of 80% is necessary to achieve a comprehensive
assessment. This should include clinical examination, any sustained reinjuries,
validated knee-specific PROs, and health-related quality of life questionnaires.
In the midterm to long-term follow-up, the presence of osteoarthritis should be
evaluated. This consensus paper provides practical guidelines for how the
aforementioned entities of outcomes should be reported and suggests the
preferred tools for a reliable and valid assessment of outcome after ACL
treatment.
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Affiliation(s)
- Eleonor Svantesson
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Eric Hamrin Senorski
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Kate E Webster
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Jón Karlsson
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Theresa Diermeier
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Sean J Meredith
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Thomas Rauer
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - James J Irrgang
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Kurt P Spindler
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - C Benjamin Ma
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | | | - Freddie H Fu
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Olufemi R Ayeni
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Francesco Della Villa
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Stefano Della Villa
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Scott Dye
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Mario Ferretti
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Alan Getgood
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Timo Järvelä
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Christopher C Kaeding
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Ryosuke Kuroda
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Bryson Lesniak
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Robert G Marx
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Gregory B Maletis
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Leo Pinczewski
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Anil Ranawat
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Bruce Reider
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Romain Seil
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Carola van Eck
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Brian R Wolf
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Patrick Yung
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Stefano Zaffagnini
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
| | - Ming Hao Zheng
- Investigation performed at UPMC Freddie Fu Sports Medicine Center, Pittsburgh, Pennsylvania, USA
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14
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Kia C, Cavanaugh Z, Gillis E, Dwyer C, Chadayammuri V, Muench LN, Berthold DP, Murphy M, Pacheco R, Arciero RA. Size of Initial Bone Bruise Predicts Future Lateral Chondral Degeneration in ACL Injuries: A Radiographic Analysis. Orthop J Sports Med 2020; 8:2325967120916834. [PMID: 32426411 PMCID: PMC7222279 DOI: 10.1177/2325967120916834] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Bone marrow contusions are common after an acute anterior cruciate ligament (ACL) injury. It is unknown whether the severity of this initial bruise can predict the potential of developing chondral changes even after ACL reconstructive surgery (ACLR). Purpose: To investigate whether the initial bone bruise area could be predictive of progressive chondral defects. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review was performed to capture patients with an acute ACL injury with pre- and post-ACLR magnetic resonance imaging (MRI) between January 2000 and December 2017. Lesion areas were measured on initial MRI, and chondral wear was graded on final imaging by use of the modified Outerbridge classification. An ordinal model was created to determine whether the initial area was a significant predictor for future chondral degeneration. Results: A total of 40 patients with a mean age of 34.5 ± 12.6 years were included for analysis. All patients underwent ACLR at a mean 139 ± 64 days from initial injury. A lateral tibial and femoral bone bruise was most commonly present in patients (77.5% and 62.5%, respectively). A medial femoral bone bruise was found in only 12.5% (5/40) of patients. The initial contusion area significantly correlated with increasing chondral wear over time in the tibia and lateral femoral condyle (P < .001). Patients with a bone bruise encompassing 100% of the lateral femoral compartment on MRI had a 74% chance of having grade 3 or 4 chondral changes at 5 years (P = .001). Absence of a bone bruise on initial MRI was the greatest predictor of no cartilage wear at 5 years in all compartments (P < .001). The presence of a concomitant lateral meniscal injury increased the risk of developing type 3 or 4 chondral wear in the lateral tibial plateau (P = .012) but did not pose increased risk of femoral wear (P = .23). Conclusion: A significant relationship between area of initial bone bruise at the time of injury and progressive posttraumatic chondral disease was found in the tibial and lateral femoral compartments.
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Affiliation(s)
- Cameron Kia
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Zachary Cavanaugh
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Edward Gillis
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Corey Dwyer
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Vivek Chadayammuri
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Lukas N Muench
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Daniel P Berthold
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA.,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Matthew Murphy
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rafael Pacheco
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Robert A Arciero
- Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, Connecticut, USA
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15
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Clinical outcomes after anterior cruciate ligament injury: panther symposium ACL injury clinical outcomes consensus group. Knee Surg Sports Traumatol Arthrosc 2020; 28:2415-2434. [PMID: 32767052 PMCID: PMC7429530 DOI: 10.1007/s00167-020-06061-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 05/10/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE A stringent outcome assessment is a key aspect for establishing evidence-based clinical guidelines for anterior cruciate ligament (ACL) injury treatment. The aim of this consensus statement was to establish what data should be reported when conducting an ACL outcome study, what specific outcome measurements should be used and at what follow-up time those outcomes should be assessed. METHODS To establish a standardized approach to assessment of clinical outcome after ACL treatment, a consensus meeting including a multidisciplinary group of ACL experts was held at the ACL Consensus Meeting Panther Symposium, Pittsburgh, PA; USA, in June 2019. The group reached consensus on nine statements by using a modified Delphi method. RESULTS In general, outcomes after ACL treatment can be divided into four robust categories-early adverse events, patient-reported outcomes, ACL graft failure/recurrent ligament disruption and clinical measures of knee function and structure. A comprehensive assessment following ACL treatment should aim to provide a complete overview of the treatment result, optimally including the various aspects of outcome categories. For most research questions, a minimum follow-up of 2 years with an optimal follow-up rate of 80% is necessary to achieve a comprehensive assessment. This should include clinical examination, any sustained re-injuries, validated knee-specific PROs and Health-Related Quality of Life questionnaires. In the mid- to long-term follow-up, the presence of osteoarthritis should be evaluated. CONCLUSION This consensus paper provides practical guidelines for how the aforementioned entities of outcomes should be reported and suggests the preferred tools for a reliable and valid assessment of outcome after ACL treatment. LEVEL OF EVIDENCE V.
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16
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Abstract
The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.
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17
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Siriwanarangsun P, Chen KC, Finkenstaedt T, Bae WC, Statum S, Gentili A, Chung CB. Patterns of cartilage degeneration in knees with medial tibiofemoral offset. Skeletal Radiol 2019; 48:931-937. [PMID: 30357459 DOI: 10.1007/s00256-018-3093-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/20/2018] [Accepted: 10/04/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if radiographic medial tibiofemoral offset (MTFO) is associated with: (1) magnetic resonance imaging (MRI) pathology of cartilage, meniscus, and ligament; and (2) a distinct pattern of lateral cartilage degeneration on MRI. MATERIALS AND METHODS Three hundred consecutive adult knee MRIs with anteroposterior (AP) radiographs were retrospectively reviewed, and 145 studies were included. MTFO was defined as a medial extension of the medial femoral condyle beyond the articular surface of the medial tibial plateau on weight-bearing AP radiographs. The patients were then divided into the MTFO (n = 61) or no-offset (n = 84) groups. On MRI data obtained on a 1.5-Tesla system, articular cartilage of the femoral condyle and tibial plateau were graded using a modified Outerbridge classification (36 sub-regions similar to whole-organ MRI Score (WORMS) system). In addition, MR pathology of the ACL, MCL, LCL, medial and lateral menisci, were determined. RESULTS Significantly increased (ANOVA p < 0.007) MR grade of the ligaments, menisci, and cartilage in the MTFO group (ranging from 0.3 to 2.5) compared to the control group (0.2 to 1.1). Color maps of the cartilage grades suggested a marked difference in both severity of degeneration and regional variations between the groups. MTFO group exhibited focally increased cartilage grades in the central, non-weight regions of lateral compartment (region p = 0.07 to 0.12, interaction p = 0.05 to 0.1). CONCLUSIONS MTFO is associated with overall degeneration of the knee and features a distinct lateral cartilage degeneration pattern, which may reflect non-physiologic contact of the cartilage between the lateral tibial eminence and lateral central femoral condyle.
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Affiliation(s)
- Palanan Siriwanarangsun
- Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Karen C Chen
- Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Dr., MC-114, San Diego, CA, 92161, USA
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Tim Finkenstaedt
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Won C Bae
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Sheronda Statum
- Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Dr., MC-114, San Diego, CA, 92161, USA
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Amilcare Gentili
- Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Dr., MC-114, San Diego, CA, 92161, USA
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA
| | - Christine B Chung
- Department of Radiology, VA San Diego Healthcare System, 3350 La Jolla Village Dr., MC-114, San Diego, CA, 92161, USA.
- Department of Radiology, University of California, San Diego, School of Medicine, San Diego, CA, USA.
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Kretzschmar M, Nevitt MC, Schwaiger BJ, Joseph GB, McCulloch CE, Link TM. Spatial distribution and temporal progression of T2 relaxation time values in knee cartilage prior to the onset of cartilage lesions - data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage 2019; 27:737-745. [PMID: 30802496 PMCID: PMC6482329 DOI: 10.1016/j.joca.2018.10.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 10/02/2018] [Accepted: 10/11/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate compositional changes of knee cartilage at the site of newly appearing cartilage lesions and the surrounding cartilage 1-4 years prior to lesion onset using quantitative T2-measurements. METHODS Fifty-seven cartilage plates with newly appearing cartilage lesions from 45 knees (cases) and 52 plates from 26 control knees from the Osteoarthritis Initiative (OAI) cohort (controls) were evaluated. Using MRI T2-mapping, composition of local (the site of future lesions) and surrounding cartilage (remainder of the cartilage plate) was assessed 1-4 years prior to lesion onset. Analogous cartilage ROIs in control plates without cartilage lesions were assessed over 1-4 years. Mixed models were used to compare T2-means and change rates between local and surrounding cartilage within cases and controls, and to compare change rates in local and surrounding cartilage between cases and controls, adjusting for covariates. RESULTS Four years prior to lesion onset, we found that local cartilage ROIs had higher T2-values compared to the surrounding cartilage. No such differences were found in control plates. In cases mean local T2-values were persistantly elevated compared to the surrounding cartilage prior to lesion onset reaching significance 1 year prior (+2.94 ms, p = 0.012). T2-values of the surrounding cartilage were also persistantly higher in cases compared to controls, reaching significance 2 years prior to lesion onset (+3.61 ms, p = 0.003). CONCLUSION The findings of our study support the concept of compositional cartilage changes as a mechanism for cartilage degradation and that both diffuse and focal changes of cartilage composition within a cartilage plate precede the development of cartilage lesions.
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Affiliation(s)
- M Kretzschmar
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - MC Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - BJ Schwaiger
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - GB Joseph
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - CE McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - TM Link
- Musculoskeletal and Quantitative Imaging Group (MQIR), Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Watt FE, Corp N, Kingsbury SR, Frobell R, Englund M, Felson DT, Levesque M, Majumdar S, Wilson C, Beard DJ, Lohmander LS, Kraus VB, Roemer F, Conaghan PG, Mason DJ. Towards prevention of post-traumatic osteoarthritis: report from an international expert working group on considerations for the design and conduct of interventional studies following acute knee injury. Osteoarthritis Cartilage 2019; 27:23-33. [PMID: 30125638 PMCID: PMC6323612 DOI: 10.1016/j.joca.2018.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE There are few guidelines for clinical trials of interventions for prevention of post-traumatic osteoarthritis (PTOA), reflecting challenges in this area. An international multi-disciplinary expert group including patients was convened to generate points to consider for the design and conduct of interventional studies following acute knee injury. DESIGN An evidence review on acute knee injury interventional studies to prevent PTOA was presented to the group, alongside overviews of challenges in this area, including potential targets, biomarkers and imaging. Working groups considered pre-identified key areas: eligibility criteria and outcomes, biomarkers, injury definition and intervention timing including multi-modality interventions. Consensus agreement within the group on points to consider was generated and is reported here after iterative review by all contributors. RESULTS The evidence review identified 37 studies. Study duration and outcomes varied widely and 70% examined surgical interventions. Considerations were grouped into three areas: justification of inclusion criteria including the classification of injury and participant age (as people over 35 may have pre-existing OA); careful consideration in the selection and timing of outcomes or biomarkers; definition of the intervention(s)/comparator(s) and the appropriate time-window for intervention (considerations may be particular to intervention type). Areas for further research included demonstrating the utility of patient-reported outcomes, biomarkers and imaging outcomes from ancillary/cohort studies in this area, and development of surrogate clinical trial endpoints that shorten the duration of clinical trials and are acceptable to regulatory agencies. CONCLUSIONS These considerations represent the first international consensus on the conduct of interventional studies following acute knee joint trauma.
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Affiliation(s)
- F E Watt
- Arthritis Research UK Centre for Osteoarthritis Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Roosevelt Drive, Oxford, OX3 7FY, United Kingdom.
| | - N Corp
- Arthritis Research UK Primary Care Centre, Institute for Primary Care & Health Sciences, Keele University, Keele, UK.
| | - S R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - R Frobell
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden.
| | - M Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden.
| | - D T Felson
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA; NIHR Biomedical Research Centre, University of Manchester, Manchester, UK.
| | - M Levesque
- Immunology Development, Abbvie Bioresearch Center, Worcester, MA, USA.
| | - S Majumdar
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology & Biomedical Imaging, University of California San Francisco, San Francisco, USA.
| | - C Wilson
- Dept of Trauma and Orthopaedics, University Health Board, Cardiff, UK.
| | - D J Beard
- Surgical Intervention Trials Unit (SITU), Nuffield Department of Orthopaedics, Rheumatology and Musculokeletal Sciences, University of Oxford, Oxford, UK.
| | - L S Lohmander
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Lund, Sweden.
| | - V B Kraus
- Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, USA.
| | - F Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - D J Mason
- Arthritis Research UK Biomechanics and Bioengineering Centre, School of Biosciences, Cardiff University, Cardiff, UK.
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20
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Chen E, Amano K, Pedoia V, Souza RB, Ma CB, Li X. Longitudinal analysis of tibiofemoral cartilage contact area and position in ACL reconstructed patients. J Orthop Res 2018; 36:2718-2727. [PMID: 29667733 PMCID: PMC7238867 DOI: 10.1002/jor.24024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 04/10/2018] [Indexed: 02/04/2023]
Abstract
Patients who have suffered ACL injury are more likely to develop early onset post-traumatic osteoarthritis despite reconstruction. The purpose of our study was to evaluate the longitudinal changes in the tibiofemoral cartilage contact area size and location after ACL injury and reconstruction. Thirty-one patients with isolated unilateral ACL injury were followed with T2 weighted Fast Spin Echo, T1ρ and T2 MRI at baseline prior to reconstruction, and 6 months, 1 year, and 2 years after surgery. Areas were delineated in FSE images with an in-house Matlab program using a spline-based semi-automated segmentation algorithm. Tibiofemoral contact area and centroid position along the anterior-posterior axis were calculated along with T1ρ and T2 relaxation times on both the injured and non-injured knees. At baseline, the injured knees had significantly smaller and more posteriorly positioned contact areas on the medial tibial surface compared to corresponding healthy knees. These differences persisted 6 months after reconstruction. Moreover, subjects with more anterior medial centroid positions at 6 months had elevated T1ρ and T2 measures in the posterior medial tibial plateau at 1 year. Changes in contact area and centroid position after ACL injury and reconstruction may characterize some of the mechanical factors contributing to post-traumatic osteoarthritis. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2718-2727, 2018.
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Affiliation(s)
- Ellison Chen
- UCSF Department of Radiology and Biomedical Imaging, 185 Berry St, Suite 350, San Francisco, California 94107
| | - Keiko Amano
- UCSF Department of Orthopaedic Surgery, San Francisco, California
| | - Valentina Pedoia
- UCSF Department of Radiology and Biomedical Imaging, 185 Berry St, Suite 350, San Francisco, California 94107
| | - Richard B. Souza
- UCSF Department of Radiology and Biomedical Imaging, 185 Berry St, Suite 350, San Francisco, California 94107,,UCSF Department of Physical Therapy and Rehabilitation Science, San Francisco, California
| | - C. Benjamin Ma
- UCSF Department of Orthopaedic Surgery, San Francisco, California
| | - Xiaojuan Li
- UCSF Department of Radiology and Biomedical Imaging, 185 Berry St, Suite 350, San Francisco, California 94107,,Program of Advanced Musculoskeletal Imaging (PAMI), Cleveland Clinic, Cleveland, Ohio
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21
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Patterson BE, Culvenor AG, Barton CJ, Guermazi A, Stefanik JJ, Morris HG, Whitehead TS, Crossley KM. Worsening Knee Osteoarthritis Features on Magnetic Resonance Imaging 1 to 5 Years After Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2018; 46:2873-2883. [PMID: 30179520 PMCID: PMC6379915 DOI: 10.1177/0363546518789685] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An anterior cruciate ligament (ACL) injury is a well-established risk factor for the long-term development of radiographic osteoarthritis (OA). However, little is known about the early degenerative changes (ie, <5 years after injury) of individual joint features (ie, cartilage, bone marrow), which may be reversible and responsive to interventions. PURPOSE To describe early degenerative changes between 1 and 5 years after ACL reconstruction (ACLR) on magnetic resonance imaging (MRI) and explore participant characteristics associated with these changes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Seventy-eight participants (48 men; median age, 32 years; median body mass index [BMI], 26 kg/m2) underwent 3.0-T MRI at 1 and 5 years after primary hamstring autograft ACLR. Early tibiofemoral and patellofemoral OA features were assessed with the MRI Osteoarthritis Knee Score. The primary outcome was worsening (ie, incident or progressive) cartilage defects, bone marrow lesions (BMLs), osteophytes, and meniscal lesions. Logistic regression with generalized estimating equations evaluated participant characteristics associated with worsening features. RESULTS Worsening of cartilage defects in any compartment occurred in 40 (51%) participants. Specifically, worsening in the patellofemoral and medial and lateral tibiofemoral compartments was present in 34 (44%), 8 (10%), and 10 (13%) participants, respectively. Worsening patellofemoral and medial and lateral tibiofemoral BMLs (14 [18%], 5 [6%], and 10 [13%], respectively) and osteophytes (7 [9%], 8 [10%], and 6 [8%], respectively) were less prevalent, while 17 (22%) displayed deteriorating meniscal lesions. Worsening of at least 1 MRI-detected OA feature, in either the patellofemoral or tibiofemoral compartment, occurred in 53 (68%) participants. Radiographic OA in any compartment was evident in 5 (6%) and 16 (21%) participants at 1 and 5 years, respectively. A high BMI (>25 kg/m2) was consistently associated with elevated odds (between 2- and 5-fold) of worsening patellofemoral and tibiofemoral OA features. CONCLUSION High rates of degenerative changes occur in the first 5 years after ACLR, particularly the development and progression of patellofemoral cartilage defects. Older patients with a higher BMI may be at particular risk and should be educated about this risk.
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Affiliation(s)
- Brooke E Patterson
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia.,Institute of Anatomy, Paracelsus Medical University, Salzburg, Austria
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Joshua J Stefanik
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Hayden G Morris
- Park Clinic Orthopaedics, St Vincent's Private Hospital, Melbourne, Victoria, Australia
| | | | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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22
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King E, Richter C, Franklyn-Miller A, Daniels K, Wadey R, Moran R, Strike S. Whole-body biomechanical differences between limbs exist 9 months after ACL reconstruction across jump/landing tasks. Scand J Med Sci Sports 2018; 28:2567-2578. [DOI: 10.1111/sms.13259] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Enda King
- Sports Medicine Research Department; Sports Surgery Clinic; Dublin Ireland
- Department of Life Sciences; Roehampton University; London UK
| | - Chris Richter
- Sports Medicine Research Department; Sports Surgery Clinic; Dublin Ireland
| | - Andy Franklyn-Miller
- Sports Medicine Research Department; Sports Surgery Clinic; Dublin Ireland
- Centre for Health, Exercise and Sports Medicine; University of Melbourne; Melbourne Vic. Australia
| | - Katherine Daniels
- Sports Medicine Research Department; Sports Surgery Clinic; Dublin Ireland
- Queen’s School of Engineering; University of Bristol; Bristol UK
| | - Ross Wadey
- School of Sport, Health, and Applied Sciences; St Mary's University; London UK
| | - Ray Moran
- Sports Medicine Research Department; Sports Surgery Clinic; Dublin Ireland
| | - Siobhan Strike
- Department of Life Sciences; Roehampton University; London UK
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23
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Kumar D, Su F, Wu D, Pedoia V, Heitkamp L, Ma B, Souza RB, Li X. Frontal Plane Knee Mechanics and Early Cartilage Degeneration in People With Anterior Cruciate Ligament Reconstruction: A Longitudinal Study. Am J Sports Med 2018; 46:378-387. [PMID: 29125920 PMCID: PMC6709529 DOI: 10.1177/0363546517739605] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Abnormal frontal plane gait mechanics are known risk factors for knee osteoarthritis, but their role in early cartilage degeneration after anterior cruciate ligament reconstruction (ACLR) is not well understood. Hypothesis/Purpose: The objective was to evaluate the association of frontal plane gait mechanics with medial knee cartilage magnetic resonance (MR) relaxation times over 1 year in patients with ACLR and controls. It was hypothesized that (1) there will be an increase in frontal plane medial knee loading and medial knee MR relaxation times over time in the patients with ACLR, and (2) increases in frontal plane medial knee loading will be associated with an increase in medial knee MR relaxation times. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients with ACLR (n = 37) underwent walking gait analyses and bilateral quantitative MR imaging (MRI) before surgery and at 6 and 12 months after ACLR. Healthy control participants (n = 13) were evaluated at baseline and 12 months. Gait variables included peak knee adduction moment (KAM), KAM impulse, and peak knee adduction angle. MRI variables included medial femur and medial tibia whole compartment and subregional T1ρ and T2 relaxation times. Statistical analyses included a comparison of changes over time for gait and MRI variables, correlations between changes in gait and MRI variables over time, and differences in change in MRI variables in patients who showed an increase versus decrease in KAM impulse. RESULTS There were significant increases in medial T1ρ (Δ 4%-11%) and T2 (Δ 2%-10%) relaxation times from baseline to 6 months for both knees in the ACLR group and in KAM (Δ 13%) for the injured knee. From baseline to 6 months, patients who had an increase in KAM impulse in the injured knee had a greater increase in medial T1ρ and T2 relaxation times as compared with those who did not have an increase in KAM impulse. Longitudinal changes for the control group were not significant. CONCLUSION There is an increase in medial knee relaxation times over the first 6 months after ACLR. People with an increase in medial knee loading show an increase in medial knee relaxation times when compared with those who do not have an increase in medial knee loading over the first 6 months.
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Affiliation(s)
- Deepak Kumar
- Department of Physical Therapy & Athletic Training, Boston University, Boston, MA,Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Favian Su
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Daniel Wu
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Valentina Pedoia
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Lauren Heitkamp
- Department of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, CA
| | - Richard B. Souza
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA,Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA
| | - Xiaojuan Li
- Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
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24
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Owusu-Akyaw KA, Heckelman LN, Cutcliffe HC, Sutter EG, Englander ZA, Spritzer CE, Garrett WE, DeFrate LE. A comparison of patellofemoral cartilage morphology and deformation in anterior cruciate ligament deficient versus uninjured knees. J Biomech 2017; 67:78-83. [PMID: 29221902 DOI: 10.1016/j.jbiomech.2017.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 11/24/2022]
Abstract
Anterior cruciate ligament (ACL) deficient patients have an increased rate of patellofemoral joint (PFJ) osteoarthritis (OA) as compared to the general population. Although the cause of post-injury OA is multi-factorial, alterations in joint biomechanics may predispose patients to cartilage degeneration. This study aimed to compare in vivo PFJ morphology and mechanics between ACL deficient and intact knees in subjects with unilateral ACL ruptures. Eight male subjects underwent baseline MRI scans of both knees. They then performed a series of 60 single-legged hops, followed by a post-exercise MRI scan. This process was repeated for the contralateral knee. The MR images were converted into three-dimensional surface models of cartilage and bone in order to assess cartilage thickness distributions and strain following exercise. Prior to exercise, patellar cartilage was significantly thicker in intact knees as compared to ACL deficient knees by 1.8%. In response to exercise, we observed average patellar cartilage strains of 5.4 ± 1.1% and 2.5 ± 1.4% in the ACL deficient and intact knees, respectively. Importantly, the magnitude of patellar cartilage strain in the ACL deficient knees was significantly higher than in the intact knees. However, while trochlear cartilage experienced a mean strain of 2.4 ± 1.6%, there was no difference in trochlear cartilage strain between the ACL deficient and uninjured knees. In summary, we found that ACL deficiency was associated with decreased patellar cartilage thickness and increased exercise-induced patellar cartilage strain when compared to the uninjured contralateral knees.
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Affiliation(s)
- Kwadwo A Owusu-Akyaw
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Lauren N Heckelman
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Hattie C Cutcliffe
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - E Grant Sutter
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Zoë A Englander
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | | | - William E Garrett
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Louis E DeFrate
- Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA; Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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25
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Li HH, Zhang XL, Ooi G, Hironori N, Sekiguchi M, Konno SI. MRI observations of patellar tendon length change after ACL reconstruction with hamstring autografts. ACTA ACUST UNITED AC 2017; 37:577-581. [PMID: 28786070 DOI: 10.1007/s11596-017-1775-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/08/2017] [Indexed: 11/24/2022]
Abstract
The post-operative patellar tendon length was studied to evaluate the possible tendon length change after anterior cruciate ligament (ACL) reconstruction with hamstring autografts. The Insall-Salvati index, modified Insall-Salvati index, curved modified Insall-Salvati index and Caton-Deschamps index were observed by MRI during a follow-up period of 12 weeks on 20 ACL reconstructed knees. The results showed no patellar baja or alta pre-existed on those ACL injured patients. After a follow-up period of 12 weeks, no patellar tendon length change was observed. It is suggested that the change of patella was not the primary reason that may contribute to the premature patellofemoral joint osteoarthritis after ACL reconstruction.
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Affiliation(s)
- Hao-Huan Li
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Xiao-Long Zhang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Gota Ooi
- Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Numazaki Hironori
- Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Miho Sekiguchi
- Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Shin-Ichi Konno
- Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, 960-1295, Japan
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26
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Bennell KL, van Ginckel A, Kean CO, Nelligan RK, French SD, Stokes M, Pietrosimone B, Blackburn T, Batt M, Hunter DJ, Spiers L, Hinman RS. Patient Knowledge and Beliefs About Knee Osteoarthritis After Anterior Cruciate Ligament Injury and Reconstruction. Arthritis Care Res (Hoboken) 2017; 68:1180-5. [PMID: 27444100 DOI: 10.1002/acr.22794] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 10/26/2015] [Accepted: 11/17/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore patients' knowledge and beliefs about osteoarthritis (OA) and OA risk following anterior cruciate ligament (ACL) injury, to explore the extent to which information about these risks is provided by health professionals, and to examine associations among participant characteristics, knowledge, and risk beliefs and health professional advice. METHODS A custom-designed survey was conducted in Australian and American adults who sustained an ACL injury, with or without reconstruction, 1-5 years prior. The survey comprised 3 sections: participant characteristics, knowledge about OA and OA risk, and health professional advice. RESULTS Complete data sets from 233 eligible respondents were analyzed. Most (70%, n = 164) rated themselves as being at greater risk of OA than their healthy peers, although only 56% (n = 130) were able to identify the correct OA definition. While most agreed that ACL (73%, n = 168) and/or meniscal injuries (n = 181, 78%) increase the risk of OA, 65% (n = 152) believed that ACL reconstruction reduced the risk of OA, or they did not know. A total of 27% (n = 62) recalled discussing their OA risk with a health professional. Participants who were female, younger, or had a lower body mass index or higher physical activity level were more likely to recognize meniscal tears and meniscectomy as risk factors of OA. A history of professional advice was associated with beliefs about increased OA risks. CONCLUSION Patients sustaining an ACL injury require better education from health professionals about OA as a disease entity and their elevated risk of OA, irrespective of whether or not they undergo surgical reconstruction.
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Affiliation(s)
- Kim L Bennell
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Crystal O Kean
- Central Queensland University, North Rockhampton, Queensland, Australia
| | | | | | - Maria Stokes
- University of Southampton and Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Southampton, UK
| | | | | | - Mark Batt
- Nottingham University Hospitals and Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, UK
| | - David J Hunter
- Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Libby Spiers
- University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- University of Melbourne, Melbourne, Victoria, Australia
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27
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Klengel A, Stumpp P, Klengel S, Böttger I, Rönisch N, Kahn T. Detection of Traumatic Bone Marrow Lesions after Knee Trauma: Comparison of ADC Maps Derived from Diffusion-weighted Imaging with Standard Fat-saturated Proton Density–weighted Turbo Spin-Echo Sequences. Radiology 2017; 283:469-477. [DOI: 10.1148/radiol.2016160306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexis Klengel
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Patrick Stumpp
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Steffen Klengel
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Ina Böttger
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Nadja Rönisch
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
| | - Thomas Kahn
- From the Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Liebigstr 20, 04103 Leipzig, Germany (A.K., P.S., T.K.); and Department of Radiology, Medical Service Center RadCom, Riesa, Germany (S.K., I.B., N.R.)
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28
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Khandha A, Manal K, Wellsandt E, Capin J, Snyder-Mackler L, Buchanan TS. Gait mechanics in those with/without medial compartment knee osteoarthritis 5 years after anterior cruciate ligament reconstruction. J Orthop Res 2017; 35:625-633. [PMID: 27082166 PMCID: PMC5065735 DOI: 10.1002/jor.23261] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
The objective of the study was to evaluate differences in gait mechanics 5 years after unilateral anterior cruciate ligament reconstruction surgery, for non-osteoarthritic (n = 24) versus osteoarthritic (n = 9) subjects. For the involved knee, the osteoarthritic group demonstrated significantly lower peak knee flexion angles (non-osteoarthritic = 24.3 ± 4.6°, osteoarthritic = 19.1 ± 2.9°, p = 0.01) and peak knee flexion moments (non-osteoarthritic = 5.3 ± 1.2% Body Weight × Height, osteoarthritic = 4.4 ± 1.2% Body Weight × Height, p = 0.05). Differences in peak knee adduction moment approached significance, with a higher magnitude for the osteoarthritic group (non-osteoarthritic = 2.4 ± 0.8% Body Weight × Height, osteoarthritic = 2.9 ± 0.5% Body Weight × Height, p = 0.09). Peak medial compartment joint load was evaluated using electromyography-informed neuromusculoskeletal modeling. Peak medial compartment joint load in the involved knee for the two groups was not different (non-osteoarthritic = 2.4 ± 0.4 Body Weight, osteoarthritic = 2.3 ± 0.6 Body Weight). The results suggest that subjects with dissimilar peak knee moments can have similar peak medial compartment joint load magnitudes. There was no evidence of inter-limb asymmetry for either group. Given the presence of inter-group differences (non-osteoarthritic vs. osteoarthritic) for the involved knee, but an absence of inter-limb asymmetry in either group, it may be necessary to evaluate how symmetry is achieved, over time, and to differentiate between good versus bad inter-limb symmetry, when evaluating knee gait parameters. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:625-633, 2017.
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Affiliation(s)
- Ashutosh Khandha
- Department of Biomedical Engineering, University of Delaware, 540 South College Avenue, Newark, Delaware 19713
| | - Kurt Manal
- Department of Mechanical Engineering, University of Delaware, Newark, Delaware
| | | | - Jacob Capin
- Department of Physical Therapy, University of Delaware, Newark, Delaware
| | | | - Thomas S. Buchanan
- Department of Biomedical Engineering, University of Delaware, 540 South College Avenue, Newark, Delaware 19713,Department of Mechanical Engineering, University of Delaware, Newark, Delaware
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29
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Wang X, Wang Y, Bennell KL, Wrigley TV, Cicuttini FM, Fortin K, Saxby DJ, Van Ginckel A, Dempsey AR, Grigg N, Vertullo C, Feller JA, Whitehead T, Lloyd DG, Bryant AL. Cartilage morphology at 2-3 years following anterior cruciate ligament reconstruction with or without concomitant meniscal pathology. Knee Surg Sports Traumatol Arthrosc 2017; 25:426-436. [PMID: 26506844 DOI: 10.1007/s00167-015-3831-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 10/06/2015] [Indexed: 01/27/2023]
Abstract
PURPOSE To examine differences in cartilage morphology between young adults 2-3 years post-anterior cruciate ligament reconstruction (ACLR), with or without meniscal pathology, and control participants. METHODS Knee MRI was performed on 130 participants aged 18-40 years (62 with isolated ACLR, 38 with combined ACLR and meniscal pathology, and 30 healthy controls). Cartilage defects, cartilage volume and bone marrow lesions (BMLs) were assessed from MRI using validated methods. RESULTS Cartilage defects were more prevalent in the isolated ACLR (69 %) and combined group (84 %) than in controls (10 %, P < 0.001). Furthermore, the combined group showed higher prevalence of cartilage defects on medial femoral condyle (OR 4.7, 95 % CI 1.3-16.6) and patella (OR 7.8, 95 % CI 1.5-40.7) than the isolated ACLR group. Cartilage volume was lower in both ACLR groups compared with controls (medial tibia, lateral tibia and patella, P < 0.05), whilst prevalence of BMLs was higher on lateral tibia (P < 0.001), with no significant differences between the two ACLR groups for either measure. CONCLUSIONS Cartilage morphology was worse in ACLR patients compared with healthy controls. ACLR patients with associated meniscal pathology have a higher prevalence of cartilage defects than ACLR patients without meniscal pathology. The findings suggest that concomitant meniscal pathology may lead to a greater risk of future OA than isolated ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Xinyang Wang
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Tim V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Karine Fortin
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - David J Saxby
- Centre for Musculoskeletal Research, Griffith University, The Gold Coast, QLD, Australia
| | - Ans Van Ginckel
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Alasdair R Dempsey
- Centre for Musculoskeletal Research, Griffith University, The Gold Coast, QLD, Australia.,School of Psychology and Exercise Science, Murdoch University, Perth, WA, Australia
| | - Nicole Grigg
- Centre for Musculoskeletal Research, Griffith University, The Gold Coast, QLD, Australia
| | | | - Julian A Feller
- OrthoSport Victoria, Epworth Richmond, Melbourne, VIC, Australia.,La Trobe University Medical Centre, Melbourne, VIC, Australia
| | - Tim Whitehead
- OrthoSport Victoria, Epworth Richmond, Melbourne, VIC, Australia
| | - David G Lloyd
- Centre for Musculoskeletal Research, Griffith University, The Gold Coast, QLD, Australia
| | - Adam L Bryant
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
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Abstract
Synopsis Although osteoarthritis (OA) has traditionally been considered a disease of older age, hip and knee OA can and does affect younger adults, with a profound impact on psychosocial well-being and work capacity. Obesity and a history of traumatic knee injury (eg, anterior cruciate ligament rupture and/or meniscal tear) are key risk factors for the accelerated development of knee OA, while structural hip deformities (including those contributing to femoroacetabular impingement syndrome) are strong predictors of early-onset hip OA. In view of these associations, rising rates of obesity and sports injuries are concerning, and may signal a future surge in OA incidence among younger people. Assessment of hip and knee OA in younger people should focus on a patient-centered history, comprehensive physical examination, performance-based measures, and patient-reported outcome measures to enable monitoring of symptoms and function over time. Referral for imaging should be reserved for people presenting with atypical signs or symptoms that may indicate diagnoses other than OA. Nonpharmacological approaches are core strategies for the management of hip and knee OA in younger people, and these include appropriate disease-related education, activity modification (including for work-related tasks), physical therapist- prescribed exercise programs to address identified physical impairments, and weight control or weight loss. High-quality evidence has shown no benefit of arthroscopy for knee OA, and there are no published clinical trials to support the use of hip arthroscopy for OA. Referral for joint-conserving or joint replacement surgery should be considered when nonpharmacological and pharmacological management strategies are no longer effective. J Orthop Sports Phys Ther 2017;47(2):67-79. doi:10.2519/jospt.2017.7286.
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Hajizadeh M, Hashemi Oskouei A, Ghalichi F, Sole G. Knee Kinematics and Joint Moments During Stair Negotiation in Participants With Anterior Cruciate Ligament Deficiency and Reconstruction: A Systematic Review and Meta-Analysis. PM R 2016; 8:563-579.e1. [DOI: 10.1016/j.pmrj.2016.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/24/2016] [Accepted: 01/27/2016] [Indexed: 01/13/2023]
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van Meer BL, Oei EHG, Meuffels DE, van Arkel ERA, Verhaar JAN, Bierma-Zeinstra SMA, Reijman M. Degenerative Changes in the Knee 2 Years After Anterior Cruciate Ligament Rupture and Related Risk Factors: A Prospective Observational Follow-up Study. Am J Sports Med 2016; 44:1524-33. [PMID: 26965680 DOI: 10.1177/0363546516631936] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a well-known risk factor for development of knee osteoarthritis. Early identification of those patients at risk and early identification of the process of ACL rupture leading to osteoarthritis may aid in preventing the onset or progression of osteoarthritis. PURPOSE To identify early degenerative changes as assessed on magnetic resonance imaging (MRI) after 2-year follow-up in patients with a recent ACL rupture and to evaluate which determinants are related to these changes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Included in this study were 154 adults aged between 18 and 45 years with acute ACL rupture diagnosed by physical examination and MRI, without previous knee trauma or surgery, and without osteoarthritic changes on radiographs. A total of 143 patients completed the 2-year follow-up, and the results in this study apply to these 143 patients. All patients were treated according to the Dutch guideline on ACL injury. Of the 143 patients, 50 patients were treated nonoperatively during the 2-year follow-up period. Main outcome was early degenerative changes assessed on MRI defined as progression of cartilage defects and osteophytes in tibiofemoral and patellofemoral compartments. Patient characteristics, activity level, functional instability, treatment type, and trauma-related variables were evaluated as determinants. RESULTS The median time between MRI at baseline and MRI at 2-year follow-up was 25.9 months (interquartile range, 24.7-26.9 months). Progression of cartilage defects in the medial and lateral tibiofemoral compartments was present in 12% and 27% of patients, and progression of osteophytes in tibiofemoral and patellofemoral compartments was present in 10% and 8% of patients, respectively. The following determinants were positively significantly associated with early degenerative changes: male sex (odds ratio [OR], 4.43; 95% CI, 1.43-13.66; P = .010), cartilage defect in the medial tibiofemoral compartment at baseline (OR, 3.66; 95% CI, 1.04-12.95; P = .044), presence of bone marrow lesions in the medial tibiofemoral compartment 1 year after trauma (OR, 5.19; 95% CI, 1.56-17.25; P = .007), joint effusion 1 year after trauma (OR, 4.19; 95% CI, 1.05-16.72; P = .042), and presence of meniscal tears (OR, 6.37; 95% CI, 1.94-20.88; P = .002). When the patients were categorized into 3 treatment groups (nonoperative, reconstruction <6 months after ACL rupture, and reconstruction ≥6 months after ACL rupture), there was no significant relationship between the treatment options and the development of early degenerative changes. CONCLUSION Two years after ACL rupture, early degenerative changes were assessed on MRI. Concomitant medial cartilage defect and meniscal injury, male sex, persistent bone marrow lesions in the medial tibiofemoral compartment, and joint effusion are risk factors for degenerative changes.
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Affiliation(s)
- Belle L van Meer
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of Sports Medicine, Medical Center Haaglanden, The Hague, the Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ewoud R A van Arkel
- Department of Orthopaedic Surgery, Medical Center Haaglanden, The Hague, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Max Reijman
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Anderson MJ, Browning WM, Urband CE, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament. Orthop J Sports Med 2016; 4:2325967116634074. [PMID: 27047983 PMCID: PMC4794976 DOI: 10.1177/2325967116634074] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). PURPOSE To quantify the number of systematic reviews and meta-analyses published on the ACL in the past decade and to provide an overall summary of this literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all ACL-related systematic reviews and meta-analyses published between January 2004 and September 2014 was performed using PubMed, MEDLINE, and the Cochrane Database. Narrative reviews and non-English articles were excluded. RESULTS A total of 1031 articles were found, of which 240 met the inclusion criteria. Included articles were summarized and divided into 17 topics: anatomy, epidemiology, prevention, associated injuries, diagnosis, operative versus nonoperative management, graft choice, surgical technique, fixation methods, computer-assisted surgery, platelet-rich plasma, rehabilitation, return to play, outcomes assessment, arthritis, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on the ACL can supply the surgeon with a single source for the most up-to-date synthesis of the literature.
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Affiliation(s)
| | | | | | | | - Leslie J. Bisson
- The State University of New York at Buffalo, Buffalo, New York, USA
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Gheno R, Yoon YC, Wang JH, Kim K, Baek SY. Changes in the T2 relaxation value of the tibiofemoral articular cartilage about 6 months after anterior cruciate ligament reconstruction using the double-bundle technique. Br J Radiol 2016; 89:20151002. [PMID: 26838956 DOI: 10.1259/bjr.20151002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate T2 relaxation values (T2RVs) of knee joint cartilage after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) in a 6-month follow-up and to correlate changes between T2RVs with meniscal status and clinical findings. METHODS 27 patients who underwent DB-ACLR and MRI before and 6 months after surgery, and 27 control subjects were enrolled. We compared T2RVs of the control vs pre-operative MR and pre-operative vs post-operative MR using 28 subcompartments, including superficial and deep layers. Correlations between T2RV changes with meniscal status and clinical data were examined. RESULTS The pre-operative T2RV was significantly higher than that of the control group in the medial tibia (posterior-superficial), posterior medial femur (superficial) and posterior lateral femur (superficial and deep). The post-operative T2RV was significantly higher than that of pre-operative T2RV in the posterior medial femur (superficial), medial tibia (anterior-deep and central-deep), lateral femur (anterior-deep, anterior-superficial and central-superficial) and posterior medial femur (deep). Moderate positive correlations between pre-operative and post-operative T2RV changes were found at the posterior medial femur (interval between injury and MR examination, and instability) and posterior lateral femur (Lysholm score). CONCLUSION Patients with anterior cruciate ligament injury followed by DB-ACLR presented short-term subcompartment T2RV changes at the medial femur, lateral femur and medial tibia. Meniscal status did not affect T2RV; however, clinical findings influenced T2RV at the posterior grooves of the medial and lateral femoral condyles. ADVANCES IN KNOWLEDGE Patients submitted to DB-ACLR presented T2RV changes in both femoral and medial tibial condyles 6 months after the surgery, affecting not just the weight-bearing areas, but also the less-weight-bearing areas.
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Affiliation(s)
- Ramon Gheno
- 1 Instituto de Radiodiagnóstico Rio Preto (Ultra-X), São José do Rio Preto, Brazil
| | - Young Cheol Yoon
- 2 Department of Radiology, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Joon H Wang
- 3 Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyunga Kim
- 4 Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
| | - Sun-Y Baek
- 4 Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea
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Wellsandt E, Gardinier ES, Manal K, Axe MJ, Buchanan TS, Snyder-Mackler L. Decreased Knee Joint Loading Associated With Early Knee Osteoarthritis After Anterior Cruciate Ligament Injury. Am J Sports Med 2016; 44:143-51. [PMID: 26493337 PMCID: PMC4703470 DOI: 10.1177/0363546515608475] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown. HYPOTHESIS Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA. RESULTS Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036). CONCLUSION Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction.
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Affiliation(s)
- Elizabeth Wellsandt
- University of Delaware, Newark, Delaware, USA.,Address correspondence to Elizabeth Wellsandt, PT, University of Delaware, 540 South College Avenue, Suite 210Z, Newark, DE 19713, USA ()
| | | | - Kurt Manal
- University of Delaware, Newark, Delaware, USA
| | - Michael J. Axe
- University of Delaware, Newark, Delaware, USA.,First State Orthopaedics, Newark, Delaware, USA
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Argentieri EC, Sturnick DR, DeSarno MJ, Gardner-Morse MG, Slauterbeck JR, Johnson RJ, Beynnon BD. Changes to the articular cartilage thickness profile of the tibia following anterior cruciate ligament injury. Osteoarthritis Cartilage 2014; 22:1453-60. [PMID: 25278056 DOI: 10.1016/j.joca.2014.06.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/16/2014] [Accepted: 06/22/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We sought to determine if anterior cruciate ligament (ACL)-injured subjects demonstrated side-to-side differences in tibial cartilage thickness soon after injury, and if uninjured-control subjects displayed side-to-side symmetry in cartilage thickness. Second, we aimed to investigate associations between body mass index (BMI), cross-sectional area (CSA) of the proximal tibia, and articular cartilage thickness differences. METHODS Bilateral Magnetic Resonance Images (MRIs) were obtained on 88 ACL-injured subjects (27 male; 61 female) a mean 27 days post-injury, and 88 matched uninjured control subjects. Within ACL-injured and uninjured control subjects, side-to-side differences in medial and lateral tibial articular cartilage thickness were analyzed with adjustment for tibial position relative to the femur during MRI acquisition. Associations between tibial CSA and cartilage thickness differences were tested within high and low BMI groups. RESULTS Within the medial tibial compartment, ACL-injured females displayed significant increases: mean (confidence interval (CI)) = +0.18 mm (0.17, 0.19) and decreases: mean (CI) = -0.14 mm (-0.13, -0.15) in tibial cartilage thickness within the central and posterior cartilage regions respectively. Adjustment for tibial position revealed a decreased area of significant cartilage thickness differences, though 46% of points maintained significance. In the lateral compartment anterior region, there was a significantly different relationship between cartilage thickness differences and CSA, within high and low BMI groups (BMI group*CSA interaction, P = 0.007). Within the low BMI group, a significant negative correlation between cartilage thickness and CSA was identified (P = 0.03). CONCLUSIONS ACL-injured females displayed cartilage thickness differences in the central, and posterior medial tibial cartilage regions. Tibial position effected thickness differences, but did not account for all significant differences.
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Affiliation(s)
- E C Argentieri
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - D R Sturnick
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - M J DeSarno
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA.
| | - M G Gardner-Morse
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - J R Slauterbeck
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - R J Johnson
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
| | - B D Beynnon
- Department of Orthopaedics and Rehabilitation, University of Vermont, Burlington, VT, USA.
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Roemer FW, Eckstein F, Hayashi D, Guermazi A. The role of imaging in osteoarthritis. Best Pract Res Clin Rheumatol 2014; 28:31-60. [PMID: 24792944 DOI: 10.1016/j.berh.2014.02.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Osteoarthritis (OA) is the most prevalent joint disorder with no approved disease-modifying treatment available. The importance of imaging in assessing all joint structures involved in the disease process, including articular cartilage, meniscus, subarticular bone marrow, and synovium for diagnosis, prognostication, and follow-up, has been well recognized. In daily clinical practice, conventional radiography is still the most commonly used imaging technique for the evaluation of a patient with known or suspected OA and radiographic outcome measures are still the only approved end point by regulatory authorities in clinical trials. The ability of magnetic resonance imaging (MRI) to visualize all joint structures in three-dimensional fashion including tissue ultrastructure has markedly deepened our understanding of the natural history of the disease. This article describes the roles and limitations of different imaging modalities for clinical practice and research in OA, with a focus on radiography and MRI and an emphasis on the knee joint.
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Affiliation(s)
- Frank W Roemer
- Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA; Department of Radiology, University of Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany; Department of Radiology, Klinikum Augsburg, Augsburg, Stenglinstr 2, 86156 Augsburg, Germany.
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University, Strubergasse 21, 5020 Salzburg, Austria.
| | - Daichi Hayashi
- Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA; Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, 267 Grant Street, Bridgeport, CT 06610, USA.
| | - Ali Guermazi
- Department of Radiology, Quantitative Imaging Center (QIC), Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA.
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Roemer FW, Frobell R, Lohmander LS, Niu J, Guermazi A. Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS): Longitudinal MRI-based whole joint assessment of anterior cruciate ligament injury. Osteoarthritis Cartilage 2014; 22:668-82. [PMID: 24657830 DOI: 10.1016/j.joca.2014.03.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/27/2014] [Accepted: 03/03/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a whole joint scoring system, the Anterior Cruciate Ligament OsteoArthritis Score (ACLOAS), for magnetic resonance imaging (MRI)-based assessment of acute anterior cruciate ligament (ACL) injury and follow-up of structural sequelae, and to assess its reliability. DESIGN Baseline and follow-up 1.5 T MRI examinations from 20 patients of the KANON study, a randomized controlled study comparing a surgical and non-surgical treatment strategy, were assessed for up to six longitudinal visits using a novel MRI scoring system incorporating acute structural tissue damage and longitudinal changes including osteoarthritis (OA) features. Joint features assessed were acute osteochondral injury, traumatic and degenerative bone marrow lesions (BMLs), meniscus morphology and extrusion, osteophytes, collateral and cruciate ligaments including ACL graft, Hoffa-synovitis and effusion-synovitis. Cross-sectional (baseline) and longitudinal (all time points and change) intra- and inter-observer reliability was calculated using weighted (w) kappa statistics and overall percent agreement on a compartmental basis (medial tibio-femoral, lateral tibio-femoral, patello-femoral). RESULTS Altogether 87 time points were evaluated. Intra-observer reliability ranged between 0.52 (baseline, Hoffa-synovitis) and 1.00 (several features), percent agreement between 52% (all time points, Hoffa-synovitis) and 100% (several features). Inter-observer reliability ranged between 0.00 and 1.00, which is explained by low frequency of some of the features. Altogether, 73% of all assessed 142 parameters showed w-kappa values between 0.80 and 1.00 and 92% showed agreement above 80%. CONCLUSIONS ACLOAS allows reliable scoring of acute ACL injury and longitudinal changes. This novel scoring system incorporates features that may be relevant for structural outcome not covered by established OA scoring instruments.
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Affiliation(s)
- Frank W Roemer
- Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany; Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA.
| | - Richard Frobell
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - L Stefan Lohmander
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden; Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jingbo Niu
- Clinical Epidemiology and Training Unit, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ali Guermazi
- Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, MA, USA
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