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Chondral Injury Associated With ACL Injury: Assessing Progressive Chondral Degeneration With Morphologic and
Emily J Davidson1, Caroline Figgie1, Joseph Nguyen1
1HSS MRI Laboratory, Hospital for Special Surgery, New York.
Sports Health
|October 25, 2023
Summary
Anterior cruciate ligament (ACL) injuries cause early cartilage damage, detectable by MRI. This damage progresses over a year, even in the uninjured knee, highlighting the need for early intervention to prevent osteoarthritis.
Area of Science:
- Orthopedics
- Radiology
- Sports Medicine
Background:
- Anterior cruciate ligament (ACL) injuries frequently lead to post-traumatic osteoarthritis (PTOA) due to associated chondral damage.
- Magnetic resonance imaging (MRI) is crucial for detecting subtle, early chondral damage, often preceding clinical and radiographic signs of PTOA.
Purpose of the Study:
- To assess early and progressive degenerative chondral changes after acute ACL injury using morphologic and quantitative MRI techniques.
- To evaluate the progression of chondral damage in both injured and contralateral knees over 12 months post-ACL injury.
Main Methods:
- A prospective longitudinal cohort study included 65 participants with acute unilateral ACL injuries.
- Bilateral knee MRI scans were performed within 1 month, 6 months, and 12 months post-injury, utilizing morphologic (modified Noyes score) and quantitative (T1ρ and T2 mapping) assessments.
- Participant-reported outcomes were recorded at follow-up intervals.
Main Results:
- Baseline MRI revealed significant cartilage damage in the injured knee, particularly the lateral tibial plateau and femoral condyle, which progressed over 1 year.
- Longitudinal MRI analysis showed significant T1ρ and T2 prolongation in multiple compartments of the injured knees at 12 months.
- The contralateral, uninjured knees also exhibited T1ρ and T2 prolongation, indicating widespread chondral changes despite improved patient-reported outcomes.
Conclusions:
- ACL injury initiates and sustains chondral damage, primarily in the lateral tibiofemoral compartment, but also affects other compartments in both knees.
- Early detection of chondral degeneration via advanced MRI techniques is vital for timely interventions to prevent or delay PTOA.
