Effect of walking on in vivo tibiofemoral cartilage strain in ACL-deficient versus intact knees

Crook, Bryan S.; Collins, Amber T.; Lad, Nimit; Spritzer, Charles E.; Wittstein, Jocelyn; DeFrate, Louis E.

doi:10.1016/j.jbiomech.2020.110210

Cited by 20 publications

(8 citation statements)

References 49 publications

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“…Hip cartilage was investigated using MRI thickness and T2 [ 75 ] and T2* relaxation time [ 76 ] measures. Online software was used to obtain percentage change or pre- and post-activity measures from graphed results, when authors were unable to supply the requested data [ 39 , 41 – 46 , 53 , 54 , 56 , 57 , 59 – 61 , 64 , 66 – 68 , 76 ].…”

Section: Resultsmentioning

confidence: 99%

“…Joint loading activity included sustained compression loading (50% body weight) applied to the foot of individuals lying within the scanner to simulate upright standing (mean duration 24 ± 13 min) [ 40 , 50 , 53 , 55 , 64 , 68 – 73 , 75 ] and a knee flexed protocol was used to simulate squatting [ 52 , 67 ]. Included studies also investigated walking [ 39 , 41 – 43 , 48 , 51 , 57 , 62 , 65 , 66 ] (mean duration 21 ± 9.7 min) and cycling [ 31 , 43 , 47 ] (mean duration 22 ± 9 min). Hopping [ 56 , 60 ], double-leg [ 54 ] and single-leg drop-jumps [ 43 ] were considered similar (hop/jump) activities and combined in meta-analyses.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies evaluated immediate cartilage thickness and volume changes [ 39 – 41 , 46 , 48 , 53 , 56 , 60 , 62 , 63 , 73 ] and six studies evaluated composition changes [ 46 , 62 , 71 , 72 , 78 , 79 ] in individuals with, or at risk of, knee OA. Comparability of cartilage regions and activities was limited; two pooled analyses identified reductions in weightbearing femoral and tibial cartilage thickness and volume following simulated standing (2.7% and 2.5%, respectively) and walking (4.4% and 4.8%), respectively (Additional files 5 and 6 ).…”

Section: Resultsmentioning

confidence: 99%

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Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis

et al. 2023

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Background The impact of activity-related joint loading on cartilage is not clear. Abnormal loading is considered to be a mechanical driver of osteoarthritis (OA), yet moderate amounts of physical activity and rehabilitation exercise can have positive effects on articular cartilage. Our aim was to investigate the immediate effects of joint loading activities on knee and hip cartilage in healthy adults, as assessed using magnetic resonance imaging. We also investigated delayed effects of activities on healthy cartilage and the effects of activities on cartilage in adults with, or at risk of, OA. We explored the association of sex, age and loading duration with cartilage changes. Methods A systematic review of six databases identified studies assessing change in adult hip and knee cartilage using MRI within 48 h before and after application of a joint loading intervention/activity. Studies included adults with healthy cartilage or those with, or at risk of, OA. Joint loading activities included walking, hopping, cycling, weightbearing knee bends and simulated standing within the scanner. Risk of bias was assessed using the Newcastle–Ottawa Scale. Random-effects meta-analysis estimated the percentage change in compartment-specific cartilage thickness or volume and composition (T2 relaxation time) outcomes. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system evaluated certainty of evidence. Results Forty studies of 653 participants were included after screening 5159 retrieved studies. Knee cartilage thickness or volume decreased immediately following all loading activities investigating healthy adults; however, GRADE assessment indicated very low certainty evidence. Patellar cartilage thickness and volume reduced 5.0% (95% CI 3.5, 6.4, I2 = 89.3%) after body weight knee bends, and tibial cartilage composition (T2 relaxation time) decreased 5.1% (95% CI 3.7, 6.5, I2 = 0.0%) after simulated standing within the scanner. Hip cartilage data were insufficient for pooling. Secondary outcomes synthesised narratively suggest knee cartilage recovers within 30 min of walking and 90 min of 100 knee bends. We found contrasting effects of simulated standing and walking in adults with, or at risk of, OA. An increase of 10 knee bend repetitions was associated with 2% greater reduction in patellar thickness or volume. Conclusion There is very low certainty evidence that minimal knee cartilage thickness and volume and composition (T2 relaxation time) reductions (0–5%) occur after weightbearing knee bends, simulated standing, walking, hopping/jumping and cycling, and the impact of knee bends may be dose dependent. Our findings provide a framework of cartilage responses to loading in healthy adults which may have utility for clinicians when designing and prescribing rehabilitation programs and providing exercise advice.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis

et al. 2023

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“…It is possible that we may not have seen a relationship between axial strain and patient-reported outcomes, due to the low magnitude of load applied to the cartilage. Our loading device applied a load of one-half body weight to the medial cartilage, whereas other experiments have calculated axial strain based on cartilage thickness changes after significant physiological loads such as long-distance running or walking, or due to activities of daily living outside of the MRI scanner [11][12][13]22,30 . In these specific situations, the cartilage would likely be loaded to at least twice body weight, and possibly as high as eight times body weight 36 .…”

Section: Discussionmentioning

confidence: 99%

MRI-derived Articular Cartilage Strains Predict Patient-Reported Outcomes Six Months Post Anterior Cruciate Ligament Reconstruction

Miller,

Lee,

Lowe

et al. 2024

Preprint

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Background: Anterior cruciate ligament (ACL) injuries lead to an increased risk of osteoarthritis, characterized by altered cartilage tissue structure and function. Displacements under applied loading by magnetic resonance imaging (dualMRI) is a novel MRI technique that can be used to quantify mechanical strain in cartilage while undergoing a physiological load. Purpose: To determine if strains derived by dualMRI and relaxometry measures correlate with patient-reported outcomes at six months post unilateral ACL reconstruction. Study Design: Cohort study Methods: Quantitative MRI (T2, T2*, T1ρ) measurements and transverse, axial, and shear strains were quantified in the medial articular tibiofemoral cartilage of 35 participants at six-months post unilateral ACL reconstruction. The relationships between patient-reported outcomes (WOMAC, KOOS, MARS) and all qMRI relaxation times were quantified using general linear mixed-effects models. A combined best-fit multicontrast MRI model was then developed using backwards regression to determine the patient features and MRI metrics that are most predictive of patient-reported outcome scores. Results: Higher femoral strains were significantly correlated with worse patient-reported functional outcomes. Femoral shear and transverse strains were positively correlated with six-month KOOS and WOMAC scores, after controlling for covariates. No relaxometry measures were correlated with patient-reported outcome scores. We identified the best-fit model for predicting WOMAC score using multiple MRI measures and patient-specific information, including sex, age, graft type, femoral transverse strain, femoral axial strain, and femoral shear strain. The best-fit model significantly predicted WOMAC score (p<0.001) better than any one individual MRI metric alone. When we regressed the model-predicted WOMAC scores against the patient-reported WOMAC scores, we found that our model achieved a goodness of fit exceeding 0.52. Conclusions: This work presents the first use of dualMRI in vivo in a cohort of participants at risk for developing osteoarthritis. Our results indicate that both shear and transverse strains are highly correlated with patient-reported outcome severity could serve as novel imaging biomarkers to predict the development of osteoarthritis.

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“…Despite the high rate of PTOA following joint injury, the factors that contribute to PTOA development remain unclear. Several studies have investigated altered knee biomechanics after ACL [8][9][10][11][12][13] and meniscus injuries [14][15][16][17][18], suggesting possible associations with PTOA. Other studies suggest that biological changes [19][20][21][22][23][24] that occur within the joint following injury may play a role in PTOA development as well.…”

Section: Introductionmentioning

confidence: 99%

Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries

et al. 2021

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Background Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries. Methods Twenty-nine patients (14 meniscus-injured and 15 ACL-injured) undergoing ACL and/or meniscus surgery but with a normal contralateral knee were recruited. During surgery, synovial fluid was aspirated from both normal and injured knees. Synovial fluid cells were pelleted, washed, and stained with an antibody cocktail consisting of fluorescent antibodies for cell surface proteins. Analysis of immune cells in the synovial fluid was performed by polychromatic flow cytometry. A broad spectrum immune cell panel was used in the first 10 subjects. Based on these results, a T cell-specific panel was used in the subsequent 19 subjects. Results Using the broad spectrum immune cell panel, we detected significantly more total viable cells and CD3 T cells in the injured compared to the paired normal knees. In addition, there were significantly more injured knees with T cells above a 500-cell threshold. Within the injured knees, CD4 and CD8 T cells were able to be differentiated into subsets. The frequency of total CD4 T cells was significantly different among injury types, but no statistical differences were detected among CD4 and CD8 T cell subsets by injury type. Conclusions Our findings provide foundational data showing that ACL and meniscus injuries induce an immune cell-rich microenvironment that consists primarily of T cells with multiple T helper phenotypes. Future studies investigating the relationship between immune cells and joint degeneration may provide an enhanced understanding of the pathophysiology of PTOA following joint injury.

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Effect of walking on in vivo tibiofemoral cartilage strain in ACL-deficient versus intact knees

Cited by 20 publications

References 49 publications

Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis

Immediate and Delayed Effects of Joint Loading Activities on Knee and Hip Cartilage: A Systematic Review and Meta-analysis

MRI-derived Articular Cartilage Strains Predict Patient-Reported Outcomes Six Months Post Anterior Cruciate Ligament Reconstruction

Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries

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