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Lower patient-reported function at 2 years is associated with elevated knee cartilage T1rho and T2 relaxation times at 5 years in young athletes after ACL reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose was to test the following hypotheses: (1) magnetic resonance imaging (MRI) markers of early knee cartilage degeneration would be present in the involved limb of young athletes after anterior cruciate ligament reconstruction (ACLR) and (2) poor knee function would be associated with MRI markers of cartilage degeneration.

Methods

Twenty-five young athletes after primary, unilateral ACLR (mean age, 16.7 years) were followed to 5-year post-return-to-sport (RTS) clearance, as a part of a larger, prospective cohort study in young athletes post-ACLR. At 2-year post-RTS, patient-reported knee function was evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS). At 5-year post-RTS, qualitative MRI sequences (3 T) and quantitative T1rho and T2 maps segmented into six regions at the femur and tibia were performed for the involved and uninvolved knee cartilages. Relaxation times were compared between knees using Holm-corrected paired t tests. Linear regression was used to examine the association between KOOS scores at 2 years and relaxation times at 5 years.

Results

Elevated T1rho and T2 relaxation times were observed in the involved knee at the anterior medial femoral condyle compared to the uninvolved knee (p = 0.006, p = 0.024, respectively). Lower KOOS-Pain, KOOS-Symptoms, KOOS-ADL, and KOOS-Sport scores at 2-year post-RTS were associated with higher T1rho or T2 relaxation times in various regions of the involved knee at 5-year post-RTS (all p < 0.05).

Conclusions

MRI markers of early cartilage degeneration were identified in the medial compartment of the involved knee in young athletes 5-year post-RTS after ACLR. Lower KOOS scores at 2-year post-RTS were associated with elevated knee cartilage T1rho and T2 relaxation times at 5-year post-RTS. Evaluating patient-reported function over time after ACLR appears to provide insight into future degenerative changes in the knee cartilage matrix.

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Acknowledgements

The authors thank the staff of the Division of Sports Medicine, the Sports and Orthopaedic Team in the Division of Occupational Therapy and Physical Therapy, and Eric Diaz, MD and Suraj Surai, PhD and in the Department of Radiology at the Cincinnati Children’s Hospital Medical Center for their contribution to this work.

Funding

This work was funded by support from the National Institutes of Health Grants R21-AR064923-02 and F32-AR055844, the National Football League Charities Medical Research Grants 2007, 2008, 2009, 2011, and the Foundation for Physical Therapy Promotion of Doctoral Studies (PODS) II Scholarship. The funding agencies had no role in the study design, collection, analysis, nor interpretation of the data presented. Additionally, the funding agencies had no involvement in the writing of the manuscript, nor the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, SHPB 386, 1720 2nd Avenue South, Birmingham, AL, USA

    Matthew P. Ithurburn

  2. School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Columbus, OH, USA

    Matthew P. Ithurburn, Kevin D. Evans & Laura C. Schmitt

  3. Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Matthew P. Ithurburn, Robert A. Magnussen & Laura C. Schmitt

  4. Advanced Radiology Services, 3264 North Evergreen Drive, Grand Rapids, MI, USA

    Andrew M. Zbojniewicz

  5. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Andrew M. Zbojniewicz

  6. Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 10001, Cincinnati, OH, USA

    Staci Thomas & Mark V. Paterno

  7. Division of Biostatistics, College of Public Health, The Ohio State University, 250 Cunz Hall, 1841 Neil Avenue, Columbus, OH, USA

    Michael L. Pennell

  8. Department of Orthopaedics, The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive, Columbus, OH, USA

    Robert A. Magnussen

  9. Division of Occupational Therapy and Physical Therapy, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue MLC 10001, Cincinnati, OH, USA

    Mark V. Paterno

  10. Division of Physical Therapy, The Ohio State University, 453 W 10th Avenue, 516 Atwell Hall, Columbus, OH, USA

    Laura C. Schmitt

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  1. Matthew P. Ithurburn
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Contributions

Authors’ contributions are listed below: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data: MPI, AMZ, ST, KDE, MLP, RAM, MVP, LCS. (2) Drafting the article or revising it critically for important intellectual content: MPI, AMZ, ST, KDE, MLP, RAM, MVP, LCS. (3) Final approval of the version to be submitted: MPI, AMZ, ST, KDE, MLP, RAM, MVP, LCS. All authors take responsibility for the integrity of the work as a whole.

Corresponding author

Correspondence to Laura C. Schmitt.

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Conflict of interest

The authors declare they have no competing interests.

Ethical approval of research on humans

The Institutional Review Board at Cincinnati Children’s Hospital Medical Center (Cincinnati, Ohio, USA) approved the protocol for this study (Project 2008-0514).

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Ithurburn, M.P., Zbojniewicz, A.M., Thomas, S. et al. Lower patient-reported function at 2 years is associated with elevated knee cartilage T1rho and T2 relaxation times at 5 years in young athletes after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 2643–2652 (2019). https://doi.org/10.1007/s00167-018-5291-x

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  • DOI: https://doi.org/10.1007/s00167-018-5291-x

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