Abstract
To study bone shape changes as a potential early feature of post-traumatic structural knee OA development, we estimated the association between meniscal status in the anterior cruciate ligament (ACL) injured knee and longitudinal condyle changes in bone surface area. We used data from the KANON trial, including 121 young ACL-injured adults. We obtained baseline and 2-year follow-up knee MRIs. Our outcome was change in the bone surface areas (mean mm2, log-transformed) in 4 locations (femur, tibia, patella, and trochlea femur) in the medial and lateral compartment from baseline to 2 years. Meniscal pathology was defined as both present at baseline and newly developed (i.e., incident or progressed) using ACLOAS. We used multilevel linear regression adjusted for baseline bone area, age, sex, body mass index, treatment arm (i.e., early or optional delayed ACL reconstruction), and location. We analyzed medial and lateral compartment separately. We present results as percentage (%) bone area change difference with 95% confidence intervals (CI). We analyzed 109 subjects (median 27 (18-36) years, 83% men) due to missing MRI information. The bone surface area increased on average by ∼2% over 2 years. The differences between knees with and without baseline meniscal pathology were 1.1% (95%CI 0.0-2.3%) and 1.4% (95%CI 0.6-2.2%) in the medial and lateral compartment, respectively, and 1.2% (95%CI 0.3-2.0%) and 1.3% (95%CI 0.6-2.0%) for medial and lateral newly developed pathology, respectively. Our finding of ∼1% increase bone area in compartment with meniscal pathology suggests a potentially important association between meniscal integrity and early bone surface area changes after ACL injury. Trial registration number ISRCTN 84752559.
Highlights
A strong risk factor for osteoarthritis (OA) is joint injury.1e6 Anterior cruciate ligament (ACL) rupture of the knee is associated with increased instability and biomechanical stress in the knee, and with damage of other important knee structures including the meniscus and the cartilage.7e10 As a consequence, on average about50% of young people with an ACL injury have been reported to develop radiographic knee OA within 10e20 years after their knee trauma
Of 121 participants in the full cohort, ten subjects were excluded from the analyses due to missing MRI measurements on bone area either at baseline or follow-up, and two subjects were excluded due to missing information on BMI (Fig. 1)
Our findings suggest that persons with an ACL injury have ~1% increase in the bone surface area if meniscal pathology or extrusion is present in the same compartment, compared to persons with ACL injury but normal meniscus integrity and no extrusion in that compartment
Summary
A strong risk factor for osteoarthritis (OA) is joint injury.1e6 Anterior cruciate ligament (ACL) rupture of the knee is associated with increased instability and biomechanical stress in the knee, and with damage of other important knee structures including the meniscus and the cartilage.7e10 As a consequence, on average about50% of young people with an ACL injury have been reported to develop radiographic knee OA within 10e20 years after their knee trauma. A strong risk factor for osteoarthritis (OA) is joint injury.1e6 Anterior cruciate ligament (ACL) rupture of the knee is associated with increased instability and biomechanical stress in the knee, and with damage of other important knee structures including the meniscus and the cartilage.7e10 As a consequence, on average about. B.A.M. Snoeker et al / Osteoarthritis and Cartilage 29 (2021) 841e848 onset.[16] Loss of meniscal function is associated with up to 6-fold increased risk for the development of structural knee OA.5,9,17e19 the association between co-existing meniscal pathology and bone shape changes is unclear. The converse is possible, that directly after trauma the meniscal pathology results in the loss of meniscal function and increased subchondral bone stress, and eventually bone remodeling and shape changes. Our aim was to determine the association between meniscal pathology and subsequent changes in both the same and the other condyle bone surface areas within the same knee
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