Gait Mechanics and T1ρ MRI of Tibiofemoral Cartilage 6 Months after ACL Reconstruction

Pfeiffer, Steven J.; Spang, Jeffrey T.; Nissman, Daniel; Lalush, David S.; Wallace, Kyle; Harkey, Matthew S.; Schmitz, Randy J.; Schwartz, Todd A.; Blackburn, J. Troy; Pietrosimone, Brian

doi:10.1249/mss.0000000000001834

Cited by 80 publications

(111 citation statements)

References 35 publications

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“…The lack of relationship between ultrasound and arthroscopy when assessing the lateral femur may be owing to different locations of cartilage being assessed by the two techniques. Since there are region-specific changes in cartilage composition after ACL injury that may be owing to alterations in location-specific joint loading throughout the knee ( Chen et al 2018 ; Pfeiffer et al 2019 ), further work is needed to ensure similar locations in comparing ultrasound and other examination methods ( e.g., MR imaging), to confirm that the same cartilage is being evaluated between techniques.…”

Section: Discussionmentioning

confidence: 99%

Femoral Cartilage Ultrasound Echo Intensity Associates with Arthroscopic Cartilage Damage

Harkey

Little

Thompson

et al. 2021

Ultrasound in Medicine & Biology

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This study compared quantitative cartilage ultrasound metrics between people with ( n = 12) and without ( n = 12) arthroscopic cartilage damage after anterior cruciate ligament injury (age, 24.9 ± 3.7 y; sex, 33% female, 67% male; days since injury = 50 ± 52). A transverse suprapatellar ultrasound assessment imaged the femoral cartilage in participants’ injured knees before a clinical arthroscopy. A custom program automatically separated a manual cartilage segmentation into standardized medial and lateral femoral regions and calculated mean thickness ( i.e., cross-sectional area/length of cartilage-bone interface), mean echo intensity and echo-intensity heterogeneity. An orthopedic surgeon assessed arthroscopic cartilage damage in the medial and lateral femoral condyles using the Outerbridge grading system (cartilage damage = Outerbridge ≥ 1). Separate logistic regressions for medial and lateral femoral cartilage were used to determine the association between each ultrasound metric and arthroscopic cartilage damage. In medial femoral cartilage, for every 1 standard deviation decrease in echo-intensity mean and heterogeneity, there is, respectively, a 91% (adjusted odds ratio, 0.09; 95% confidence interval, 0.01–0.69) and 97% (adjusted odds ratio, 0.03; 95% confidence interval, 0.002–0.50) increase in the odds of having arthroscopic cartilage damage. Lateral cartilage ultrasound metrics are not associated with lateral arthroscopic cartilage damage. This study provides preliminary evidence that femoral cartilage ultrasound echo intensity is a non-invasive measure associated with medial femoral cartilage health after anterior cruciate ligament injury.

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Section: Discussionmentioning

confidence: 99%

Femoral Cartilage Ultrasound Echo Intensity Associates with Arthroscopic Cartilage Damage

Harkey

Little

Thompson

et al. 2021

Ultrasound in Medicine & Biology

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“…Alternatively, walking more slowly, coupled with other associated biomechanical changes, may contribute to the pathogenesis of patellofemoral OA by changing the direction, magnitude, and duration of forces (thereby also altering pressure) acting on the patellofemoral articular cartilage . Given that lower medial tibiofemoral joint contact forces are associated with tibiofemoral OA after ACLR, it is not surprising that slower walking speeds and, to a lesser degree, reduced knee excursions and lower quadriceps muscle forces—which collectively cause lower patellofemoral joint contact forces—were related to femoral trochlear cartilage degradation after ACLR. Cartilage responds to cyclic loading and may need an appropriate loading stimulus to maintain homeostasis.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies investigating the association between walking mechanics and post‐traumatic OA, however, have examined the tibiofemoral joint, rather than the patellofemoral joint. These studies have found that unloading the tibiofemoral joint, especially its medial compartment, early after ACLR is associated with future tibiofemoral OA . One study by Culvenor et al found that those with established, radiographic patellofemoral OA approximately 9 years after ACLR walked with altered mechanics at that time.…”

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confidence: 99%

Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction

Capin

Williams

Neal

et al. 2019

Journal Orthopaedic Research

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Post‐traumatic patellofemoral osteoarthritis (OA) is prevalent after anterior cruciate ligament reconstruction (ACLR) and early cartilage degradation may be especially common in the femoral trochlear cartilage. Determining the presence of and factors associated with early femoral trochlear cartilage degradation, a precursor to OA, is a critical preliminary step in identifying those at risk for patellofemoral OA development and designing interventions to combat the disease. Early cartilage degradation can be detected using quantitative magnetic resonance imaging measures, such as tissue T2 relaxation time. The purposes of this study were to (i) compare involved (ACLR) versus uninvolved (contralateral) femoral trochlear cartilage T2 relaxation times 6 months after ACLR, and (ii) determine the relationship between walking speed and walking mechanics 3 months after ACLR and femoral trochlear cartilage T2 relaxation times 6 months after ACLR. Twenty‐six individuals (age 23 ± 7 years) after primary, unilateral ACLR participated in detailed motion analyses 3.3 ± 0.6 months after ACLR and quantitative magnetic resonance imaging 6.3 ± 0.5 months after ACLR. There were no limb differences in femoral trochlear cartilage T2 relaxation times. Slower walking speed was related to higher (worse) femoral trochlear cartilage T2 relaxation times in the involved limb (Pearson's r: −0.583, p = 0.002) and greater interlimb differences in trochlear T2 relaxation times (Pearson's r: −0.349, p = 0.080). Walking mechanics were weakly related to trochlear T2 relaxation times. Statement of clinical significance: Slower walking speed was by far the strongest predictor of worse femoral trochlear cartilage health, suggesting slow walking speed may be an early clinical indicator of future patellofemoral OA after ACLR. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:645–652, 2020

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“…Animal models suggest that higher loading rates disrupt cartilage structure and biosynthesis . However, recent data in humans indicate that lower loading rates during walking 6 months post‐ACLR are associated with altered tibiofemoral cartilage composition (i.e., lower proteoglycan density) and metabolism . Future research is necessary to determine the influence of loading rate on knee joint health following ACLR.…”

Section: Discussionmentioning

confidence: 99%

Somatosensory Function Influences Aberrant Gait Biomechanics Following Anterior Cruciate Ligament Reconstruction

Blackburn

Pietrosimone

Spang

et al. 2019

Journal Orthopaedic Research

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Osteoarthritis is common following anterior cruciate ligament reconstruction (ALCR), and aberrant gait biomechanics are considered a primary contributor. Somatosensory dysfunction potentially alters gait biomechanics, but this association is unclear. Therefore, the purposes of this investigation were to compare somatosensory function between limbs and evaluate associations between somatosensory function and gait biomechanics linked to osteoarthritis development in individuals with ALCR. Seventy‐three volunteers with ALCR participated. Gait biomechanics (peak vertical ground reaction force magnitude and loading rate, peak internal knee extension and valgus moments, peak knee flexion and varus angles, and quadriceps/hamstrings co‐activation) were assessed as subjects walked at their preferred speed. The somatosensory function was assessed via joint position sense error (knee flexion) and vibratory perception threshold (femoral epicondyles, malleoli, and first metatarsal). Though somatosensory function did not differ between the ACLR and contralateral limbs, poorer joint position sense in the ACLR limb was associated with lower loading rates and internal knee extension moments, and greater co‐activation. Poorer vibratory perception at the medial and lateral malleoli and first metatarsal head in the ACLR limb was associated with lower loading rates, greater internal knee valgus moments and varus angles, and greater co‐activation. Poorer vibratory perception at the medial malleolus and first metatarsal head in the contralateral limb was associated with greater peak knee varus angles and internal knee valgus moments. These results suggest that future research evaluating rehabilitation approaches for improving somatosensory function is warranted as a potential approach for restoring normal gait biomechanics and reducing osteoarthritis risk. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:620–628, 2020

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Gait Mechanics and T1ρ MRI of Tibiofemoral Cartilage 6 Months after ACL Reconstruction

Cited by 80 publications

References 35 publications

Femoral Cartilage Ultrasound Echo Intensity Associates with Arthroscopic Cartilage Damage

Femoral Cartilage Ultrasound Echo Intensity Associates with Arthroscopic Cartilage Damage

Slower Walking Speed Is Related to Early Femoral Trochlear Cartilage Degradation After ACL Reconstruction

Somatosensory Function Influences Aberrant Gait Biomechanics Following Anterior Cruciate Ligament Reconstruction

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