Tibiofemoral joint structural change from 2.5 to 4.5\u2009years following ACL reconstruction with and without combined meniscal pathology

Christopher J Vertullo,Price Gallie,Yuanyuan Wang,David G Lloyd,Adam L Bryant,Ans Van Ginckel,Tim V Wrigley,Kim L Bennell,Julian A Feller,Karine Fortin,David J Saxby,Xinyang Wang,Tim Whitehead,Flavia M Cicuttini

doi:10.1186/s12891-019-2687-9

Abstract

BackgroundPeople who have had anterior cruciate ligament reconstruction (ACLR) are at a high risk of developing tibiofemoral joint (TFJ) osteoarthritis (OA), with concomitant meniscal injury elevating this risk. This study aimed to investigate OA-related morphological change over 2 years in the TFJ among individuals who have undergone ACLR with or without concomitant meniscal pathology and in healthy controls. A secondary aim was to examine associations of baseline TFJ cartilage defects and bone marrow lesions (BML) scores with tibial cartilage volume change in ACLR groups.MethodsFifty seven ACLR participants aged 18–40 years (32 isolated ACLR, 25 combined meniscal pathology) underwent knee magnetic resonance imaging (MRI) 2.5 and 4.5 years post-surgery. Nine healthy controls underwent knee MRI at the ~ 2-year intervals. Tibial cartilage volume, TFJ cartilage defects and BMLs were assessed from MRI.ResultsFor both ACLR groups, medial and lateral tibial cartilage volume increased over 2 years (P < 0.05). Isolated ACLR group had greater annual percentage increase in lateral tibial cartilage volume compared with controls and with the combined group (P = 0.03). Cartilage defects remained unchanged across groups. Both ACLR groups showed more lateral tibia BML regression compared with controls (P = 0.04). Baseline cartilage defects score was positively associated with cartilage volume increase at lateral tibia (P = 0.002) while baseline BMLs score was inversely related to medial tibia cartilage volume increase (P = 0.001) in the pooled ACLR group.ConclusionsTibial cartilage hypertrophy was apparent in ACLR knees from 2.5 to 4.5 years post-surgery and was partly dependent upon meniscal status together with the nature and location of the underlying pathology at baseline. Magnitude and direction of change in joint pathologies (i.e., cartilage defects, BMLs) were less predictable and either remained stable or improved over follow-up.

Highlights

People who have had anterior cruciate ligament reconstruction (ACLR) are at a high risk of developing tibiofemoral joint (TFJ) osteoarthritis (OA), with concomitant meniscal injury elevating this risk
Sixty-six participants from the three groups were tested at baseline and follow-up: i) isolated ACLR (n = 32); ii) combined ACLR and meniscal pathology (n = 25) and, iii) control (n = 9)
No significant differences were found for any other variables. Of those tested at baseline, 57/100 ACLR participants and 9/30 healthy controls returned for follow-up testing

Summary

Introduction

People who have had anterior cruciate ligament reconstruction (ACLR) are at a high risk of developing tibiofemoral joint (TFJ) osteoarthritis (OA), with concomitant meniscal injury elevating this risk. This study aimed to investigate OA-related morphological change over 2 years in the TFJ among individuals who have undergone ACLR with or without concomitant meniscal pathology and in healthy controls. Anterior cruciate ligament (ACL) injury is a common knee injury that primarily affects young, active individuals. ACLR does not protect against knee structural degeneration and at 10 years post-ACLR, around 30% of individuals exhibit tibiofemoral joint (TFJ) osteoarthritis (OA) [2,3,4]. Concomitant meniscal injury elevates the prevalence of TFJ OA by 2–4 times compared to knees with isolated ACL injury [3, 5, 6]. Assessment of early structural changes in the knee may help clarify the pathophysiology of post-traumatic OA and identify risk factors for disease onset and progression

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