Diffusion tensor imaging of the anterior cruciate ligament following primary repair with internal bracing: A longitudinal study

Dyck, Pieter Van; Froeling, Martijn; Heusdens, Christiaan H.W.; Sijbers, Jan; Ribbens, Annemie; Billiet, Thibo

doi:10.1002/jor.24684

Cited by 8 publications

(4 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…DTI results are different from conventional MRI, as DTI provides information about tissue microstructure and its degree of organization by quantifying water diffusion. Their findings suggest that healing of the ACL is incomplete at 24 months post‐operatively [6]. We observed overall poor ACL healing on MRI in six (19.4%) of our study patients during the 2‐year follow‐up.…”

Section: Discussionmentioning

confidence: 57%

Suture tape augmentation ACL repair, stable knee, and favorable PROMs, but a re-rupture rate of 11% within 2 years

Heusdens

Blockhuys

Roelant

et al. 2021

Knee Surg Sports Traumatol Arthrosc

Self Cite

View full text Add to dashboard Cite

Purpose The aim of this study is to investigate clinical and magnetic resonance imaging (MRI) outcomes after anterior cruciate ligament (ACL) repair using the suture tape augmentation (STA) technique. Methods This prospective interventional case series included 35 patients who underwent STA ACL repair and were all followed up for 2 years. The ACL rupture was between 4 and 12 weeks old and per-operatively conirmed repairable. The International Knee Documentation Committee (IKDC), and Lysholm and Tegner scores were collected together with return to work (RTW), return to sport (RTS), re-rupture, and re-intervention rate. Lachman testing was performed and ACL healing was evaluated on MRI using a grading scale based on the ACL's morphology and signal intensity with grade 1 representing good ACL healing and grade 3 representing poor ACL healing. ResultsThe number of patients who returned to their pre-rupture level for IKDC, Lysholm, and Tegner scores at 2 years of follow-up are 17/26 (65.4%), 13/25 (52.0%), and 18/27 (66.7%) patients, respectively. Median RTW and RTS periods were 5.5 weeks (range 0-32 weeks) and 6 months (range 2-22 months), respectively. The Lachman side-to-side diference decreased signiicantly (P < 0.001) to less than 3 mm after surgery and remained stable. Four patients [11.4%, 95% CI (3.2, 26.7)] sufered from a re-rupture and three other patients [8.6%, 95% CI (1.8, 23.1)] needed a re-intervention for another reason than re-rupture. MRI follow-up of 31 patients showed overall grade 1 ACL healing in 14 (45.2%) patients, grade 2 ACL healing in 11 (35.5%) patients, and grade 3 ACL healing in 6 (19.4%) patients. A higher risk of re-rupture was associated with grade 3 ACL healing at 6 months post-operatively and a pre-operative Tegner score of ≥ 7. ConclusionThis study shows that treatment of the acute, repairable ACL with the STA technique leads to a stable knee and favorable patient-reported outcome measures (PROMs). However, the re-rupture rate of 11.4% within the 2-year follow-up is a concern. Level of evidence IV.

show abstract

Section: Discussionmentioning

confidence: 57%

Suture tape augmentation ACL repair, stable knee, and favorable PROMs, but a re-rupture rate of 11% within 2 years

Heusdens

Blockhuys

Roelant

et al. 2021

Knee Surg Sports Traumatol Arthrosc

Self Cite

View full text Add to dashboard Cite

show abstract

“…20-23 Recently, DTI and tractography have been developed to study the complex collagen fiber structures of connective tissues in knee joint. 24,25 Compared with T2 and QSM, DTI estimates the fiber direction by detecting the signal decay at different diffusion gradient directions with no need to physical rotate the specimen or subject. 26-30 Diffusion tractography of the anterior cruciate ligament (ACL) graft has been proved to be feasible on clinical 3-T MRI scanners and can provide a reliable estimation of quantitative diffusion indices of the ACL graft.…”

Section: Introductionmentioning

confidence: 99%

Effects of Angular Resolution and b Value on Diffusion Tensor Imaging in Knee Joint

et al. 2021

View full text Add to dashboard Cite

Objective To investigate the influences of the diffusion gradient directions (angular resolution) and the strength of the diffusion gradient ( b value) on diffusion tensor imaging (DTI) metrics and tractography of various connective tissues in knee joint. Design Two rat knee joints were scanned on a preclinical 9.4-T system using a 3-dimensional diffusion-weighted spin echo pulse sequence. One protocol with b value of 500, 1500, and 2500 s/mm2 were acquired separately using 43 diffusion gradient directions. The other protocol with b value of 1000 s/mm2 was performed using 147 diffusion gradient directions. The in-plane resolution was 45 µm isotropic. Fractional anisotropy (FA) and mean diffusivity (MD) were compared at different angular resolution. Tractography was quantitatively evaluated at different b values and angular resolutions in cartilage, ligament, meniscus, and growth plate. Results The ligament showed higher FA value compared with growth plate and cartilage. The FA values were largely overestimated at the angular resolution of 6. Compared with FA, MD showed less sensitivity to the angular resolution. The fiber tracking was failed at low angular resolution (6 diffusion gradient directions) or high b value (2500 s/mm2). The quantitative measurements of tract length and track volume were strongly dependent on angular resolution and b value. Conclusions To obtain consistent DTI outputs and tractography in knee joint, the scan may require a proper b value (ranging from 500 to 1500 s/mm2) and sufficient angular resolution (>14) with signal-to-noise ratio >10.

show abstract

“…Dyck et al demonstrated the feasibility and reliability of DTI for the visualization and quantitative evaluation of the ACL graft using a clinical 3T system 77 . DTI provided objective biomarkers to assess graft healing following ACL reconstruction to guide the time of return to sports 77–79 . The zonal‐dependent DTI metrics (FA, MD, axial, and transversal diffusivity) of the porcine meniscus have been recently reported using a 3D DW‐SE sequence 80 .…”

Section: Musculoskeletal Applications Of Quantitative Diffusionmentioning

confidence: 99%

“…77 DTI provided objective biomarkers to assess graft healing following ACL reconstruction to guide the time of return to sports. [77][78][79] The zonal-dependent DTI metrics (FA, MD, axial, and transversal diffusivity) of the porcine meniscus have been recently reported using a 3D DW-SE sequence. 80 The complex collagen fiber architecture of the entire meniscus can be resolved by diffusion tractography.…”

Section: Ligaments Tendons and Meniscimentioning

confidence: 99%

Applications of Diffusion‐Weighted MRI to the Musculoskeletal System

Raya

Duarte

Wang

et al. 2023

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Diffusion‐weighted imaging (DWI) is an established MRI technique that can investigate tissue microstructure at the scale of a few micrometers. Musculoskeletal tissues typically have a highly ordered structure to fulfill their functions and therefore represent an optimal application of DWI. Even more since disruption of tissue organization affects its biomechanical properties and may indicate irreversible damage. The application of DWI to the musculoskeletal system faces application‐specific challenges on data acquisition including susceptibility effects, the low T2 relaxation time of most musculoskeletal tissues (2–70 msec) and the need for sub‐millimetric resolution. Thus, musculoskeletal applications have been an area of development of new DWI methods. In this review, we provide an overview of the technical aspects of DWI acquisition including diffusion‐weighting, MRI pulse sequences and different diffusion regimes to study tissue microstructure. For each tissue type (growth plate, articular cartilage, muscle, bone marrow, intervertebral discs, ligaments, tendons, menisci, and synovium), the rationale for the use of DWI and clinical studies in support of its use as a biomarker are presented. The review describes studies showing that DTI of the growth plate has predictive value for child growth and that DTI of articular cartilage has potential to predict the radiographic progression of joint damage in early stages of osteoarthritis. DTI has been used extensively in skeletal muscle where it has shown potential to detect microstructural and functional changes in a wide range of muscle pathologies. DWI of bone marrow showed to be a valuable tool for the diagnosis of benign and malignant acute vertebral fractures and bone metastases. DTI and diffusion kurtosis have been investigated as markers of early intervertebral disc degeneration and lower back pain. Finally, promising new applications of DTI to anterior cruciate ligament grafts and synovium are presented. The review ends with an overview of the use of DWI in clinical routine.Evidence Level5Technical EfficacyStage 3

show abstract

Diffusion tensor imaging of the anterior cruciate ligament following primary repair with internal bracing: A longitudinal study

Cited by 8 publications

References 52 publications

Suture tape augmentation ACL repair, stable knee, and favorable PROMs, but a re-rupture rate of 11% within 2 years

Suture tape augmentation ACL repair, stable knee, and favorable PROMs, but a re-rupture rate of 11% within 2 years

Effects of Angular Resolution and b Value on Diffusion Tensor Imaging in Knee Joint

Applications of Diffusion‐Weighted MRI to the Musculoskeletal System

Contact Info

Product

Resources

About