HSS MRI Laboratory, Hospital for Special Surgery, New York.
University of California San Francisco, San Francisco, California.
Sports Health. 2024 Sep-Oct;16(5):722-734. doi: 10.1177/19417381231205276. Epub 2023 Oct 25.
Anterior cruciate ligament (ACL) injuries are associated with a risk of post-traumatic osteoarthritis due to chondral damage. Magnetic resonance imaging (MRI) techniques provide excellent visualization and assessment of cartilage and can detect subtle and early chondral damage. This is often preceding clinical and radiographic post-traumatic osteoarthritis.
Morphologic and quantitative MRI techniques can assess early and progressive degenerative chondral changes after acute ACL injury.
Prospective longitudinal cohort.
Level 3.
Sixty-five participants with acute unilateral ACL injuries underwent bilateral knee MRI scans within 1 month of injury. Fifty-seven participants presented at 6 months, while 54 were evaluated at 12 months. MRI morphologic evaluation using a modified Noyes score assessed cartilage signal alteration, chondral damage, and subchondral bone status. Quantitative T1ρ and T2 mapping at standardized anatomic locations in both knees was assessed. Participant-reported outcomes at follow-up time points were recorded.
Baseline Noyes scores of MRI detectable cartilage damage were highest in the injured knee lateral tibial plateau (mean 2.5, standard error (SE) 0.20, < 0.01), followed by lateral femoral condyle (mean 2.1, SE 0.18, < 0.01), which progressed after 1 year. Longitudinal prolongation at 12 months in the injured knees was significant for T1ρ affecting the medial and lateral femoral condyles ( < 0.01) and trochlea ( < 0.01), whereas T2 values were prolonged for medial and lateral femoral condyles ( < 0.01) and trochlea ( < 0.01). The contralateral noninjured knees also demonstrated T1ρ and T2 prolongation in the medial and lateral compartment chondral subdivisions. Progressive chondral damage occurred despite improved patient-reported outcomes.
After ACL injury, initial and sustained chondral damage predominantly affects the lateral tibiofemoral compartment, but longitudinal chondral degeneration also occurred in other compartments of the injured and contralateral knee.
Early identification of chondral degeneration post-ACL injury using morphological and quantitative MRI techniques could enable interventions to be implemented early to prevent or delay PTOA.
前交叉韧带（ACL）损伤会导致软骨损伤，从而增加创伤后骨关节炎的风险。磁共振成像（MRI）技术可提供出色的软骨可视化和评估，并能检测到细微和早期的软骨损伤。这种损伤通常先于临床和放射学创伤后骨关节炎。
形态学和定量 MRI 技术可评估急性 ACL 损伤后早期和进行性退行性软骨变化。
前瞻性纵向队列研究。
3 级。
65 例单侧急性 ACL 损伤患者在损伤后 1 个月内接受双侧膝关节 MRI 扫描。57 例患者在 6 个月时就诊，54 例在 12 个月时评估。使用改良的 Noyes 评分对 MRI 形态学评估评估软骨信号改变、软骨损伤和软骨下骨状况。评估双侧膝关节标准化解剖位置的定量 T1ρ 和 T2 映射。记录随访时间点的患者报告结局。
MRI 可检测到的软骨损伤的基线 Noyes 评分在受伤侧胫骨平台外侧最高（平均 2.5，标准误差 0.20，<0.01），其次是外侧股骨髁（平均 2.1，SE 0.18，<0.01），1 年后进展。12 个月时，受伤侧膝关节 T1ρ 延长具有统计学意义，影响内侧和外侧股骨髁（<0.01）和滑车（<0.01），而 T2 值延长见于内侧和外侧股骨髁（<0.01）和滑车（<0.01）。对侧未受伤的膝关节在内侧和外侧间室的软骨细分中也表现出 T1ρ 和 T2 延长。尽管患者报告的结局有所改善，但仍出现进行性软骨损伤。
ACL 损伤后，初始和持续的软骨损伤主要影响外侧胫股关节，但受伤和对侧膝关节的其他关节也发生了纵向软骨退变。
使用形态学和定量 MRI 技术早期识别 ACL 损伤后的软骨退变，可早期实施干预措施，以预防或延迟 PTOA。
