Abstract

ObjectiveDiagnostic ultrasound provides a valid assessment of cartilage health that has been used to observe cross-sectional cartilage thickness differences post-ACLR (anterior cruciate ligament reconstruction), but has not been used longitudinally during early recovery post-ACLR.DesignThe purpose of this study was to assess longitudinal changes in femoral cartilage thickness via ultrasound in individuals at 4 to 6 months post-ACLR and compared to healthy controls. Twenty participants (50% female, age = 21.1 ± 5.7 years) completed testing sessions 4 and 6 months post-ACLR. Thirty healthy controls (57% female, age = 20.8 ± 3.8 years) without knee injury history completed 2 testing sessions (>72 hours apart). Femoral cartilage ultrasound images were captured bilaterally in ACLR participants and in the dominant limb of healthy controls during all sessions. Average cartilage thicknesses in the medial, intercondylar, and lateral femoral regions were determined using a semi-automated processing technique.ResultsWhen comparing cartilage thickness mean differences or changes over time, individuals post-ACLR did not demonstrate between limb differences (P-range = 0.50-0.92), limb differences compared to healthy controls (P-range = 0.19-0.94), or changes over time (P-range = 0.22-0.72) for any femoral cartilage thickness region. However, participants demonstrated cartilage thickening (45%) or thinning (35%) that exceeded minimal detectable change (MDC) from 4 to 6 months post-ACLR, respectively.ConclusionsUsing MDC scores may help better identify within-subject femoral cartilage thickness changes longitudinally post-ACLR due to bidirectional cartilage thickness changes.

Highlights

  • One third of individuals with anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) demonstrate tibiofemoral or patellofemoral osteoarthritis (OA) within 10 years of injury.[1,2] It is imperative to identify individuals who demonstrate early changes in knee joint health post-ACLR to determine which individuals may be at increased risk for OA and may benefit from OA prevention strategies before irreversible tissue damage has occurred

  • All participants recovering from ACLR (n = 20) completed both visits at 4 and 6 months post-ACLR, and all healthy control participants (n = 30) completed the follow-up visit to assess reliability at least 3 days after the initial visit

  • The ACLR group demonstrated greater pre-injury activity levels compared to the current activity level of healthy controls (P < 0.001)

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Summary

Introduction

One third of individuals with anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) demonstrate tibiofemoral or patellofemoral osteoarthritis (OA) within 10 years of injury.[1,2] It is imperative to identify individuals who demonstrate early changes in knee joint health post-ACLR to determine which individuals may be at increased risk for OA and may benefit from OA prevention strategies before irreversible tissue damage has occurred. As a result of these barriers, there is a lack of follow-up imaging that occurs during the first year after ACLR despite the fact that one third of patients will display MRI evidence of OA by 1 year post-ACLR.[2]

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