Hada Shinnosuke, Tomura Jun, Kim Youngji, Yoshida Keiichi, Kaneko Haruka, Saita Yoshitomo, Kubota Mitsuaki, Takazawa Yuji, Ishijima Muneaki
Department of Orthopaedic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan.
BMC Musculoskelet Disord. 2025 Jul 18;26(1):690. doi: 10.1186/s12891-025-08950-z.
Posttraumatic osteoarthritis (PTOA), a subtype of knee osteoarthritis (OA), develops following intra-articular injuries such as fractures, ligament tears, or meniscal damage, accounting for approximately 12% of symptomatic knee OA. Notably, 87% of patients with anterior cruciate ligament (ACL) injuries are expected to develop PTOA, and there is currently no established method to prevent its progression. While ACL reconstruction (ACL-R) restores joint stability, it does not necessarily halt PTOA development. Previous MRI-based studies have identified medial meniscal extrusion (MME) and medial tibial osteophyte (MTO) formation as early indicators of PTOA. Moreover, ACL-R can trigger intra-articular hematoma and inflammation, especially due to the drilling of bone tunnels for graft insertion. Larger graft diameters may cause more joint trauma; however, their association with early PTOA changes remains unclear. This study aimed to investigate the relationship between graft diameter and early PTOA progression as observed on MRI.
This retrospective cohort study included 42 patients (30 males, 12 females) who underwent arthroscopic ACL-R by a single surgeon. MRI scans were obtained preoperatively and once postoperatively, between 5 and 12 months after surgery. Graft diameter was measured at both femoral and tibial tunnel sites using a cylindrical sizer, and the average value was used for analysis. PTOA changes were assessed based on progression of MME and osteophyte formation. Patients were categorized into larger and smaller graft groups using the cohort's median graft diameter (9.25 mm) as the cutoff.
Graft diameter significantly correlated with MME progression (ΔMME: r = 0.48, p = 0.001) and MTO progression (ΔMTO: r = 0.31, p = 0.048). ΔMME also strongly correlated with ΔMTO (r = 0.67, p < 0.001), but not with medial femoral osteophyte (ΔMFO: r = 0.23, p = 0.15) or lateral compartment changes. The larger graft group exhibited significantly greater ΔMME (p = 0.005) and ΔMTO (p = 0.03) compared to the smaller graft group.
Larger graft diameters were associated with greater early progression of MME and MTO following ACL-R. These findings suggest a possible mechanical or inflammatory contribution to early PTOA development after reconstruction.
创伤后骨关节炎（PTOA）是膝关节骨关节炎（OA）的一种亚型，在诸如骨折、韧带撕裂或半月板损伤等关节内损伤后发生，约占有症状膝关节OA的12%。值得注意的是，预计87%的前交叉韧带（ACL）损伤患者会发展为PTOA，目前尚无既定方法来预防其进展。虽然ACL重建（ACL-R）可恢复关节稳定性，但不一定能阻止PTOA的发展。先前基于MRI的研究已将内侧半月板挤压（MME）和内侧胫骨骨赘（MTO）形成确定为PTOA的早期指标。此外，ACL-R可引发关节内血肿和炎症，尤其是由于为植入移植物而钻骨隧道所致。较大直径的移植物可能会导致更多的关节创伤；然而，它们与早期PTOA变化之间的关联仍不清楚。本研究旨在探讨移植物直径与MRI观察到的早期PTOA进展之间的关系。
这项回顾性队列研究纳入了42例患者（30例男性，12例女性），这些患者均由同一位外科医生进行关节镜下ACL-R手术。术前以及术后5至12个月进行一次MRI扫描。使用圆柱形测量器在股骨和胫骨隧道部位测量移植物直径，并取平均值进行分析。根据MME和骨赘形成的进展评估PTOA变化。以队列的移植物直径中位数（9.25毫米）作为临界值，将患者分为较大移植物组和较小移植物组。
移植物直径与MME进展（ΔMME：r = 0.48，p = 0.001）和MTO进展（ΔMTO：r = 0.31，p = 0.048）显著相关。ΔMME与ΔMTO也密切相关（r = 0.67，p < 0.001），但与股骨内侧骨赘（ΔMFO：r = 0.23，p = 0.15）或外侧间室变化无关。与较小移植物组相比，较大移植物组的ΔMME（p = 0.005）和ΔMTO（p = 0.03）显著更大。
较大直径的移植物与ACL-R术后MME和MTO的早期进展更大有关。这些发现提示了重建后早期PTOA发展可能存在机械性或炎症性作用。
