Department of Orthopaedics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA.
Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
Knee Surg Sports Traumatol Arthrosc. 2023 May;31(5):1690-1698. doi: 10.1007/s00167-022-07000-8. Epub 2022 Jun 15.
Quantitative magnetic resonance imaging (qMRI) has been used to determine the failure properties of ACL grafts and native ACL repairs and/or restorations. How these properties relate to future clinical, functional, and patient-reported outcomes remain unknown. The study objective was to investigate the relationship between non-contemporaneous qMRI measures and traditional outcome measures following Bridge-Enhanced ACL Restoration (BEAR). It was hypothesized that qMRI parameters at 6 months would be associated with clinical, functional, and/or patient-reported outcomes at 6 months, 24 months, and changes from 6 to 24 months post-surgery.
Data of BEAR patients (n = 65) from a randomized control trial of BEAR versus ACL reconstruction (BEAR II Trial; NCT02664545) were utilized retrospectively for the present analysis. Images were acquired using the Constructive Interference in Steady State (CISS) sequence at 6 months post-surgery. Single-leg hop test ratios, arthrometric knee laxity values, and International Knee Documentation Committee (IKDC) subjective scores were determined at 6 and 24 months post-surgery. The associations between traditional outcomes and MRI measures of normalized signal intensity, mean cross-sectional area (CSA), volume, and estimated failure load of the healing ACL were evaluated based on bivariate correlations and multivariable regression analyses, which considered the potential effects of age, sex, and body mass index.
CSA (r = 0.44, p = 0.01), volume (r = 0.44, p = 0.01), and estimated failure load (r = 0.48, p = 0.01) at 6 months were predictive of the change in single-leg hop ratio from 6 to 24 months in bivariate analysis. CSA (β = 0.42, p = 0.01), volume (β = 0.42, p = 0.01), and estimated failure load (β = 0.48, p = 0.01) remained significant predictors when considering the demographic variables. No significant associations were observed between MRI variables and either knee laxity or IKDC when adjusting for demographic variables. Signal intensity was also not significant at any timepoint.
The qMRI-based measures of CSA, volume, and estimated failure load were predictive of a positive functional outcome trajectory from 6 to 24 months post-surgery. These variables measured using qMRI at 6 months post-surgery could serve as prospective markers of the functional outcome trajectory from 6 to 24 months post-surgery, aiding in rehabilitation programming and return-to-sport decisions to improve surgical outcomes and reduce the risk of reinjury.
Level II.
定量磁共振成像（qMRI）已被用于确定 ACL 移植物和 ACL 修复物/重建物的失效特性。这些特性与未来的临床、功能和患者报告的结果之间的关系尚不清楚。本研究的目的是探讨 Bridge-Enhanced ACL Restoration（BEAR）后非同期 qMRI 测量值与传统结局测量值之间的关系。假设 6 个月时的 qMRI 参数与术后 6、24 个月时的临床、功能和/或患者报告的结局以及从 6 个月到 24 个月的变化有关。
回顾性分析了 BEAR 与 ACL 重建（BEAR II 试验；NCT02664545）的随机对照试验中 BEAR 患者（n=65）的数据，用于本分析。在手术后 6 个月时使用 Constructive Interference in Steady State（CISS）序列获取图像。在术后 6 和 24 个月时，测定单腿跳跃试验比值、关节内松弛值和国际膝关节文献委员会（IKDC）主观评分。基于双变量相关性和多变量回归分析，评估传统结局与愈合 ACL 的标准化信号强度、平均横截面积（CSA）、体积和估计失效负荷的 MRI 测量值之间的相关性，同时考虑年龄、性别和体重指数的潜在影响。
在双变量分析中，6 个月时 CSA（r=0.44，p=0.01）、体积（r=0.44，p=0.01）和估计失效负荷（r=0.48，p=0.01）与 6 至 24 个月时单腿跳跃比的变化相关。在考虑人口统计学变量时，CSA（β=0.42，p=0.01）、体积（β=0.42，p=0.01）和估计失效负荷（β=0.48，p=0.01）仍然是显著的预测因子。当调整人口统计学变量时，MRI 变量与膝关节松弛度或 IKDC 之间没有显著相关性。在任何时间点，信号强度均不显著。
6 个月时基于 qMRI 的 CSA、体积和估计失效负荷的测量值可预测术后 6 至 24 个月的功能结局轨迹。术后 6 个月时使用 qMRI 测量的这些变量可以作为术后 6 至 24 个月功能结局轨迹的前瞻性标志物，有助于康复计划和重返运动的决策，以改善手术结果并降低再次受伤的风险。
II 级。
