Annals of Nuclear Medicine

, Volume 33, Issue 3, pp 201–210 | Cite as

Distribution of bone tracer uptake in symptomatic knees after ACL reconstruction compared to asymptomatic non-operated knees: a method for better differentiating patient-specific from disease-specific bone tracer uptake in SPECT/CT

  • Dominic T. MathisEmail author
  • Lukas Büel
  • Helmut Rasch
  • Felix Amsler
  • Michael T. Hirschmann
  • Rolf W. Hügli
Original Article



To evaluate the differences of bone tracer uptake (BTU) in symptomatic and asymptomatic contralateral knees in patients after reconstruction of the anterior cruciate ligament (ACL-R) and to identify typical BTU patterns and threshold values to differentiate pathological from physiological BTU.


53 patients after unilateral ACL-R were retrospectively included in the study. The population was subdivided into a group of symptomatic operated knees and a group of contralateral asymptomatic non-operated knees. BTU was measured in SPECT/CT using a validated anatomical localization-scheme and normalized mean BTU values were calculated in both knees. Wilcoxon signed rank-test and Pearson’s rank-correlation coefficient were used (p < 0.05).


Symptomatic knees after ACL-R showed significantly more BTU than asymptomatic ones (p < 0.01).Based on the measured BTU activity in SPECT/CT in symptomatic operated and asymptomatic non-operated knees, intensity thresholds of pathological BTU were established. A BTU threshold of greater than the Median + 1 SD of the asymptomatic non-operated knee was defined as pathological. In both groups the highest mean BTU was found on the femoral, tibial and patellar articular surfaces, the lowest BTU in femoral and tibial regions far from the joint.


The established BTU thresholds for SPECT/CT in knees after ACL-R help to differentiate disease-specific from patient-specific BTU. It could be speculated that BTU in asymptomatic knees equates to the preoperative condition of the knee joint before ACL-R. Therefore, the results of this study help to understand in-vivo loading of the knee and ultimately lead to prediction of development of osteoarthritis in an early stage.


Anterior cruciate ligament reconstructionm SPECT CT Physiological pattern recognition Knee Osteoarthritis 



Felix Amsler kindly provided statistical advice for this manuscript. The authors would like to thank Mr Patrick Jaeger for the graphical formatting.


The authors state that this work has not received any funding.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interests.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All patients gave their informed consent and the study was approved by the local ethical committee (Ethikkommission Nordwest- und Zentralschweiz 2016-01509).


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Copyright information

© The Japanese Society of Nuclear Medicine 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery and TraumatologyKantonsspital Baselland (Bruderholz, Liestal, Laufen)BruderholzSwitzerland
  2. 2.Institute of Radiology and Nuclear MedicineKantonsspital BasellandBruderholzSwitzerland
  3. 3.Amsler ConsultingBaselSwitzerland
  4. 4.University of BaselBaselSwitzerland

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