Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Division of Musculoskeletal Imaging, Department of Medical Imaging, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Am J Sports Med. 2024 Mar;52(4):909-918. doi: 10.1177/03635465241228193. Epub 2024 Feb 22.
Concerns have arisen that anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) may accelerate the development of posttraumatic osteoarthritis in the lateral compartment of the knee.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate whether the augmentation of ACLR with LET affects the quality of lateral compartment articular cartilage on magnetic resonance imaging (MRI) at 2 years postoperatively. We hypothesized that there would be no difference in T1rho and T2 relaxation times when comparing ACLR alone with ACLR + LET.
Randomized controlled trial; Level of evidence, 1.
A consecutive subgroup of patients at the Fowler Kennedy Sport Medicine Clinic participating in the STABILITY 1 Study underwent bilateral 3-T MRI at 2 years after surgery. The primary outcome was T1rho and T2 relaxation times. Articular cartilage in the lateral compartment was manually segmented into 3 regions of the tibia (lateral tibia [LT]-1 to LT-3) and 5 regions of the femur (lateral femoral condyle [LFC]-1 to LFC-5). Analysis of covariance was used to compare relaxation times between groups, adjusted for lateral meniscal tears and treatment, cartilage and bone marrow lesions, contralateral relaxation times, and time since surgery. Semiquantitative MRI scores according to the Anterior Cruciate Ligament OsteoArthritis Score were compared between groups. Correlations were used to determine the association between secondary outcomes (including results of the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Lower Extremity Functional Scale, 4-Item Pain Intensity Measure, hop tests, and isokinetic quadriceps and hamstring strength tests) and cartilage relaxation.
A total of 95 participants (44 ACLR alone, 51 ACLR + LET) with a mean age of 18.8 years (61.1% female [58/95]) underwent 2-year MRI (range, 20-36 months). T1rho relaxation times were significantly elevated for the ACLR + LET group in LT-1 (37.3 ± 0.7 ms vs 34.1 ± 0.8 ms, respectively; = .005) and LFC-2 (43.9 ± 0.9 ms vs 40.2 ± 1.0 ms, respectively; = .008) compared with the ACLR alone group. T2 relaxation times were significantly elevated for the ACLR + LET group in LFC-1 (51.2 ± 0.7 ms vs 49.1 ± 0.7 ms, respectively; = .03) and LFC-4 (45.9 ± 0.5 ms vs 44.2 ± 0.6 ms, respectively; = .04) compared with the ACLR alone group. All effect sizes were small to medium. There was no difference in Anterior Cruciate Ligament OsteoArthritis Scores between groups ( = .99). Weak negative associations ( = -0.27 to -0.22; < .05) were found between relaxation times and quadriceps and hamstring strength in the anterolateral knee, while all other correlations were nonsignificant ( > .05).
Increased relaxation times demonstrating small to medium effect sizes suggested early biochemical changes in articular cartilage of the anterolateral compartment in the ACLR + LET group compared with the ACLR alone group. Further evidence and long-term follow-up are needed to better understand the association between these results and the potential risk of the development of osteoarthritis in our patient cohort.
人们担心前交叉韧带重建（ACLR）联合外侧关节外肌腱固定术（LET）可能会加速膝关节外侧间室的创伤后骨关节炎的发展。
目的/假设：本研究旨在评估 ACLR 联合 LET 是否会影响术后 2 年 MRI 外侧间室关节软骨的质量。我们假设 ACLR 单独与 ACLR+LET 相比，T1rho 和 T2 弛豫时间没有差异。
随机对照试验；证据水平，1 级。
在 Fowler Kennedy 运动医学诊所参与 STABILITY 1 研究的连续亚组患者在手术后 2 年接受双侧 3-T MRI。主要结局是 T1rho 和 T2 弛豫时间。外侧间室的软骨手动分为胫骨（外侧胫骨[LT]-1 至 LT-3）和股骨（外侧股骨髁[LFC]-1 至 LFC-5）的 5 个区域。采用协方差分析比较组间弛豫时间，调整外侧半月板撕裂和治疗、软骨和骨髓病变、对侧弛豫时间以及手术时间。根据前交叉韧带骨关节炎评分比较组间的半定量 MRI 评分。采用相关性分析确定次要结局（包括国际膝关节文献委员会评分、膝关节损伤和骨关节炎结局评分、下肢功能量表、4 项疼痛强度测量、跳跃测试以及等速股四头肌和腘绳肌力量测试）与软骨弛豫之间的关系。
共有 95 名参与者（44 名 ACLR 单独，51 名 ACLR+LET），平均年龄 18.8 岁（61.1%女性[58/95]）接受了 2 年的 MRI（范围 20-36 个月）。与 ACLR 单独组相比，ACLR+LET 组的 LT-1（37.3 ± 0.7 ms 比 34.1 ± 0.8 ms； =.005）和 LFC-2（43.9 ± 0.9 ms 比 40.2 ± 1.0 ms； =.008）的 T1rho 弛豫时间显著升高。与 ACLR 单独组相比，ACLR+LET 组的 LFC-1（51.2 ± 0.7 ms 比 49.1 ± 0.7 ms； =.03）和 LFC-4（45.9 ± 0.5 ms 比 44.2 ± 0.6 ms； =.04）的 T2 弛豫时间显著升高。所有效应大小均为小至中等。组间前交叉韧带骨关节炎评分无差异（ =.99）。在膝关节前外侧，弛豫时间与股四头肌和腘绳肌强度之间存在弱负相关（ = -0.27 至-0.22； <.05），而其他所有相关性均无统计学意义（ >.05）。
与 ACLR 单独组相比，ACLR+LET 组外侧间室前侧的关节软骨显示出 T1rho 和 T2 弛豫时间的小到中等程度的变化，表明存在早期生化变化。需要进一步的证据和长期随访，以更好地了解这些结果与我们患者队列中骨关节炎发展的潜在风险之间的关系。
