Patients With Abnormal Limb Kinetics at 6 Months After Anterior Cruciate Ligament Reconstruction Have an Increased Risk of Persistent Medial Meniscal Abnormality at 3 Years

Abstract

Background: Several reports have shown that altered biomechanics after anterior cruciate ligament reconstruction (ACLR) are associated with the development of posttraumatic osteoarthritis. However, it is not fully understood whether altered biomechanics are associated with meniscal changes after ACLR. Purpose: To investigate changes in gait and landing biomechanics over a 3-year period and their correlation with meniscal matrix alterations present before and after ACLR through use of magnetic resonance T1ρ/T2 mapping, which can allow detection of early meniscal degeneration. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 36 patients with ACLR and 14 healthy controls were included in this study. All patients underwent magnetic resonance imaging and biomechanical analysis during gait of the injured knee and contralateral knee preoperatively and at 6 months, 1 year, 2 years, and 3 years after ACLR, as well as biomechanical analysis during drop-landing from 6 months to 3 years postoperatively. To evaluate biochemical changes of the mensical matrix, T1ρ/T2 relaxation times of the meniscus were calculated. Results: Mean T1ρ/T2 values of ACLR knees were significantly higher than values in the contralateral and control knees in the posterior lateral and medial horns up to 1 year after surgery; however, the differences were not seen at 3 years after surgery. The ACLR knee exhibited significantly lower peak knee flexion moment and angle during gait at 6 months compared with baseline and continued to decrease until 3 years. The ACLR knee exhibited significantly lower peak vertical ground-reaction force and peak knee flexion moment and angle during landing at 6 months. However, the differences were no longer present at 3 years. Biomechanics at 6 months had significant correlations with changes of mean T1ρ/T2 values in the medial posterior horn from 6 months to 3 years after ACLR. Conclusion: Although mean T1ρ/T2 values of meniscus seen before ACLR improved after 3 years, approximately 30% of patients with ACLR did not show decreases from 6 months to 3 years. Patients with abnormal lower limb kinetics of the ACLR knee at 6 months showed less recovery in the medial posterior horn from 6 months to 3 years, suggesting that biomechanical parameters during the early stage of recovery might be potential biomarkers for predicting persistent medial meniscal abnormality after ACLR.

Radiomics Feature Analysis of Cartilage and Subchondral Bone in Differentiating Knees Predisposed to Posttraumatic Osteoarthritis after Anterior Cruciate Ligament Reconstruction from Healthy Knees

“…Therefore, there is a more compelling need to improve diagnostic techniques in order to detect PTOA at an early stage. T2 mapping has made the greatest strides in the evaluation of cartilage degeneration, which is a well-established early indicator of PTOA in patients after ACLR [16][17][18]. However, mean T2 6 BioMed Research International value analysis is somewhat subject to many common limitations, such as dependency of loading [19], sequence type [20], or parameter selection [21].…”

Kinetic Asymmetry During a Repetitive Tuck Jump Task in Athletes with a History of Anterior Cruciate Ligament Reconstruction

“…6,10,11 These persistent kinetic asymmetries may increase risk of a secondary ACL injury 24 and/or contribute to knee degenerative changes. 11,25,26 As a result, there appears to be a need to explore novel rehabilitation approaches that could potentially more effectively target these persistent kinetic asymmetries. For instance, providing visual feedback related to side-to-side differences in limb loading during movement performance may be particularly effective for promoting inter-limb kinetic symmetry and minimizing maladaptive changes in an athlete's movement pattern following ACL reconstruction.…”

Innovative rehabilitative bracing with applied resistance improves walking pattern recovery in the early stages of rehabilitation after ACL reconstruction: a preliminary investigation

“…It has been shown that hamstrings weakness after ACL reconstruction may alter knee mechanics during gait [14]. This creates aberrant adaptations, shifting cartilage loading and therefore contributing to the development of joint degenerative process [38][39][40]. In addition, the presence of hamstrings weakness after surgery seems to be related to the kind of rehabilitation undertaken by the patients [41], thus, early postoperative approaches aiming at targeting hamstrings strengthening and restoring normal gait from the first phases may be helpful in the long-term morphofunctional recovery perspective.…”