Department of Physical Therapy and Center for Exercise Medicine, University of Alabama at Birmingham, SHPB 386, 1720 2nd Avenue South, Birmingham, AL, USA.
School of Health and Rehabilitation Sciences, The Ohio State University, 453 W 10th Avenue, Columbus, OH, USA.
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2643-2652. doi: 10.1007/s00167-018-5291-x. Epub 2018 Nov 16.
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.
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.
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).
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.
本研究旨在验证以下假设：（1）前交叉韧带重建（ACLR）后，年轻运动员患侧膝关节的早期软骨退变的磁共振成像（MRI）标志物将会出现；（2）膝关节功能较差与软骨退变的 MRI 标志物相关。
25 名接受初次单侧 ACLR 的年轻运动员（平均年龄 16.7 岁）作为前瞻性队列研究中年轻 ACLR 运动员的一部分，在术后 5 年重返运动（RTS）获得许可后进行随访。在 RTS 后 2 年，使用膝关节损伤和骨关节炎结果评分（KOOS）评估患者的膝关节功能。在 RTS 后 5 年，对患侧和健侧膝关节进行 3T 定性 MRI 序列和定量 T1rho 和 T2 图谱分析，图谱将股骨和胫骨分为 6 个区域。使用 Holm 校正配对 t 检验比较膝关节之间的弛豫时间。使用线性回归分析 2 年时 KOOS 评分与 5 年时弛豫时间之间的相关性。
与健侧膝关节相比，患侧膝关节前内侧股骨髁的 T1rho 和 T2 弛豫时间升高（p=0.006，p=0.024）。RTS 后 2 年时 KOOS 疼痛、症状、ADL 和运动评分较低与 RTS 后 5 年时患侧膝关节各区域的 T1rho 或 T2 弛豫时间升高相关（均 p<0.05）。
在 ACLR 后 5 年 RTS 后，年轻运动员患侧膝关节内侧间室出现早期软骨退变的 MRI 标志物。RTS 后 2 年时 KOOS 评分较低与 RTS 后 5 年时膝关节软骨 T1rho 和 T2 弛豫时间升高相关。随着时间的推移评估 ACLR 后患者的功能似乎可以深入了解膝关节软骨基质的未来退行性变化。
