Patellar cartilage increase following ACL reconstruction with and without meniscal pathology: a two-year prospective MRI morphological study

Abstract Background Anterior cruciate ligament reconstruction (ACLR) together with concomitant meniscal injury are risk factors for the development of tibiofemoral (TF) osteoarthritis (OA), but the potential effect on the patellofemoral (PF) joint is unclear. The aim of this study was to: (i) investigate change in patellar cartilage morphology in individuals 2.5 to 4.5 years after ACLR with or without concomitant meniscal pathology and in healthy controls, and (ii) examine the association between baseline patellar cartilage defects and patellar cartilage volume change. Methods Thirty two isolated ACLR participants, 25 ACLR participants with combined meniscal pathology and nine healthy controls underwent knee magnetic resonance imaging (MRI) with 2-year intervals (baseline = 2.5 years post-ACLR). Patellar cartilage volume and cartilage defects were assessed from MRI using validated methods. Results Both ACLR groups showed patellar cartilage volume increased over 2 years (p < 0.05), and isolated ACLR group had greater annual percentage cartilage volume increase compared with controls (mean difference 3.6, 95% confidence interval (CI) 1.0, 6.3%, p = 0.008) and combined ACLR group (mean difference 2.2, 95% CI 0.2, 4.2%, p = 0.028). Patellar cartilage defects regressed in the isolated ACLR group over 2 years (p = 0.02; Z = − 2.33; r = 0.3). Baseline patellar cartilage defect score was positively associated with annual percentage cartilage volume increase (Regression coefficient B = 0.014; 95% CI 0.001, 0.027; p = 0.03) in the pooled ACLR participants. Conclusions Hypertrophic response was evident in the patellar cartilage of ACLR participants with and without meniscal pathology. Surprisingly, the increase in patellar cartilage volume was more pronounced in those with isolated ACLR. Although cartilage defects stabilised in the majority of ACLR participants, the severity of patellar cartilage defects at baseline influenced the magnitude of the cartilage hypertrophic response over the subsequent ~ 2 years.

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Corrigendum to “Moderate to vigorous physical activity is associated with greater patellar cartilage volume over 2 years following anterior cruciate ligament reconstruction” [Osteoarthritis Cartilage 24 (2016) S195–S196]

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2016.06.004 ◽

2016 ◽

Vol 24 (9) ◽

pp. 1665

Author(s):

M. Hall ◽

X. Wang ◽

K. Fortin ◽

A. Van Ginckel ◽

K.L. Bennell ◽

...

Keyword(s):

Physical Activity ◽

Anterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Vigorous Physical Activity ◽

Cartilage Volume ◽

Osteoarthritis Cartilage ◽

Cruciate Ligament Reconstruction ◽

Patellar Cartilage ◽

Anterior Cruciate

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Moderate to vigorous physical activity is associated with greater patellar cartilage volume over 2 years following anterior cruciate ligament reconstruction

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2016.01.385 ◽

2016 ◽

Vol 24 ◽

pp. S195-S196

Author(s):

M. Hall ◽

X. Wang ◽

K. Fortin ◽

K.L. Bennell ◽

T.V. Wrigley ◽

...

Keyword(s):

Physical Activity ◽

Anterior Cruciate Ligament ◽

Anterior Cruciate Ligament Reconstruction ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Vigorous Physical Activity ◽

Cartilage Volume ◽

Cruciate Ligament Reconstruction ◽

Patellar Cartilage ◽

Anterior Cruciate

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How Are Obesity and Body Composition Related to Patellar Cartilage? A Systematic Review

The Journal of Rheumatology ◽

10.3899/jrheum.151384 ◽

2017 ◽

Vol 44 (7) ◽

pp. 1071-1082 ◽

Cited By ~ 5

Author(s):

Sultana Monira Hussain ◽

Mae Chyi Tan ◽

Krista Stathakopoulos ◽

Flavia M. Cicuttini ◽

Yuanyuan Wang ◽

...

Keyword(s):

Body Composition ◽

Longitudinal Studies ◽

Statistical Significance ◽

Cartilage Volume ◽

Fat Free Mass ◽

Cartilage Defects ◽

High Quality Research ◽

Cross Sectional ◽

Mesh Terms ◽

Patellar Cartilage

Objective.The aim of this review was to systematically examine the evidence for an association between measures of obesity [weight and body mass index (BMI)] and body composition (fat mass and fat-free mass) and patellar cartilage, assessed using magnetic resonance imaging.Methods.Three electronic databases (MEDLINE, EMBASE, and CINAHL) were searched up to April 2016 using full text and MeSH terms to identify studies examining the associations between obesity and body composition, and patellar cartilage. Two independent reviewers extracted the data and assessed the methodological quality of included studies.Results.Seventeen studies were included: 5 cross-sectional, 10 cohort studies measuring outcomes at 2 timepoints, and 2 longitudinal studies assessing outcome only at the timepoint. Eleven studies were of high or moderate quality. In asymptomatic middle-aged adults, elevated body weight and BMI were systematically associated with worse patellofemoral cartilage scores. There was more consistent evidence for patellar cartilage defects than patellar cartilage volume, particularly in women. Increased BMI was also consistently associated with increased cartilage loss in longitudinal studies, although not all attained statistical significance.Conclusion.There is a need for more high-quality research to confirm these findings and to better explain the relative contributions of metabolic and biomechanical factors to the initiation of patellofemoral osteoarthritis, to devise effective strategies to manage this common and disabling condition.

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Responsiveness of Magnetic Resonance Imaging-derived Measures Over 2.7 Years

The Journal of Rheumatology ◽

10.3899/jrheum.130953 ◽

2014 ◽

Vol 41 (10) ◽

pp. 2060-2067 ◽

Cited By ~ 8

Author(s):

Dawn Aitken ◽

Changhai Ding ◽

Jean-Pierre Pelletier ◽

Johanne Martel-Pelletier ◽

Flavia Cicuttini ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Cartilage Volume ◽

Cartilage Defects ◽

Sensitivity To Change ◽

Bone Area ◽

Resonance Imaging ◽

Tibial Bone ◽

Meniscal Pathology ◽

And Cartilage

Objective.To compare the responsiveness of magnetic resonance imaging (MRI)-derived measures of knee osteoarthritis over 2.7 years.Methods.There were 430 community-based participants (mean age 63.0 yrs, range 51–79 yrs; 51% female) measured at baseline and 2.7 years later. MRI of the right knee at both timepoints was performed to assess cartilage volume, cartilage defects, bone marrow lesions (BML), meniscal pathology, and tibial bone area. Global measurements were calculated as the sum of tibial and femoral measures. Standardized response mean (SRM) was calculated as the mean of change divided by the SD of change.Results.Global tibiofemoral cartilage volume and cartilage defects had the best SRM of −0.80 and 0.62, respectively. Site-specific measurements were lower (SRM range for cartilage volume −0.48 to −0.54 and cartilage defects 0.33 to 0.49). The SRM for BML was 0.12, meniscal pathology 0.39, and tibial bone area −0.09. Cartilage volume and/or defects tended to be more responsive in those with knee pain, those who were obese, those who were older, and those with radiographic osteoarthritis.Conclusion.Global cartilage volume demonstrated the best sensitivity to change, suggesting that if we relied solely on SRM to optimize clinical trial design, then cartilage volume would be the best outcome measure. However, clinical trials have shown that cartilage volume may be less responsive to treatment compared to other measures that have lower SRM (such as BML). Therefore, although one can optimize trial efficiency by finding more responsive endpoints, both sensitivity to change and magnitude of benefit should be considered.

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The association between objectively measured physical activity and knee structural change using MRI

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-201691 ◽

2012 ◽

Vol 72 (7) ◽

pp. 1170-1175 ◽

Cited By ~ 61

Author(s):

Dawn A Doré ◽

Tania Maree Winzenberg ◽

Changhai Ding ◽

Petr Otahal ◽

Jean-Pierre Pelletier ◽

...

Keyword(s):

Physical Activity ◽

Structural Change ◽

Weight Bearing ◽

Cartilage Volume ◽

Community Dwelling ◽

Cartilage Defects ◽

Longitudinal Association ◽

Meniscal Pathology ◽

The Right ◽

Objectively Measured

ObjectivesThis study describes the longitudinal association between objectively assessed physical activity (PA) and knee structural change measured using MRI.Methods405 community-dwelling adults aged 51–81 years were measured at baseline and approximately 2.7 years later. MRI of the right knee at baseline and follow-up was performed to evaluate bone marrow lesions (BMLs), meniscal pathology, cartilage defects, and cartilage volume. PA was assessed at baseline by pedometer (steps/day).ResultsDoing ≥10 000 steps/day was associated with BML increases (RR 1.97, 95% CI 1.19 to 3.27, p=0.009). Participants doing ≥10 000 steps/day had a 1.52 times (95% CI 1.05 to 2.20, p=0.027) greater risk of increasing meniscal pathology score, which increased to 2.49 (95% CI 1.05 to 3.93, p=0.002) in those with adverse meniscal pathology at baseline. Doing ≥10 000 steps/day was associated with a greater risk of increasing cartilage defect score in those with prevalent BMLs at baseline (RR 1.36, 95% CI 1.03 to 1.69, p=0.013). Steps/day was protective against volume loss in those with more baseline cartilage volume but led to increased cartilage loss in those with less baseline cartilage volume. (p=0.046 for interaction).ConclusionsPA was deleteriously associated with knee structural change, especially in those with pre-existing knee structural abnormalities. This suggests individuals with knee abnormalities should avoid doing ≥10 000 steps/day. Alternatives to weight-bearing activity may be needed in order to maintain PA levels required for other aspects of health.

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Evaluation of Positive Contrast Arthrography in Canine Cranial Cruciate Ligament Disease

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632495 ◽

1996 ◽

Vol 09 (01) ◽

pp. 10-3 ◽

Cited By ~ 2

Author(s):

D.N. Aron ◽

R. Roberts ◽

J. Stallings ◽

J. Brown ◽

C.W. Hay

Keyword(s):

Articular Surface ◽

Cruciate Ligament ◽

Positive Contrast ◽

Joint Effusion ◽

Radiographic Evaluation ◽

Cranial Cruciate Ligament ◽

Joint Pathology ◽

Meniscal Pathology ◽

Cranial Cruciate Ligament Disease ◽

Better Than

SummaryArthrographic and intraoperative evaluations of stifles affected with cranial cruciate disease were compared. Arthrography did not appear to be helpful in predicting cranial cruciate ligament pathology. The caudal cruciate ligament was consistently not visualized in the arthrograms and was normal at surgery. The menisci were visualized consistently in the arthrograms, but conclusions could not be made as to the benefit of arthrography in predicting meniscal pathology. Arthrography was not helpful in predicting joint capsule and femoral articular surface pathology. Survey radiographic evaluation was better than arthrography in evaluating joint pathology. When cruciate injury is suspected, after history and physical examination, survey radiographs are better than positive contrast arthrograms at supporting the diagnosis.Positive contrast arthrography was evaluated as a diagnostic aid in canine cranial cruciate ligament disease. It did not appear to be useful in predicting joint pathology. With arthrography, both menisci could be visualized and evaluated for abnormalities. Joint effusion and presence of osteophytes evaluated on survey radiographs was better than arthrography in evaluating joint pathology.

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