Effects of Surgical Factors on Cartilage Can Be Detected Using Quantitative Magnetic Resonance Imaging After Anterior Cruciate Ligament Reconstruction
Effects of Surgical Factors on Cartilage Can Be Detected Using Quantitative Magnetic Resonance Imaging After Anterior Cruciate Ligament Reconstruction
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DOI：
10.1177/0363546516677794
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发表时间：
2017-04-01
影响因子：
4.8
通讯作者：
Majumdar, Sharmila
中科院分区：
文献类型：
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作者：
Amano, Keiko;Li, Alan K.;Majumdar, Sharmila
背景：定量磁共振（qMR）可用于测量组织中的大分子，是一种观察创伤后骨关节炎发展过程中早期软骨变化的潜在方法。假设/目的：我们假设影响前交叉韧带（ACL）重建（ACLR）后软骨基质组成的特定患者和手术因素可以通过T1 rho和T2松弛时间来检测。我们的目的是在多中心可行性研究中证明这种能力。研究设计：病例系列；证据等级，4级。方法：54例ACLR患者术前基线及术后6个月行双侧MRI检查。记录手术结果。计算股骨内侧、股骨外侧、胫骨内侧、胫骨外侧、髌骨和滑车6个软骨区域的T1 rho和T2松弛时间。配对t检验比较了基线和6个月时的放松时间，单变量回归确定了影响患者报告的结果测量的区域，协方差分析用于确定导致6个月时放松时间增加的手术因素。结果：损伤膝关节在基线和6个月时胫股腔室T1 rho和T2松弛时间明显延长，但髌股腔室的T1 rho和T2松弛时间较未损伤膝关节短。在6个月时，损伤和未损伤膝盖的T1 rho和T2时间延长。在6个月时，延长胫骨区域的T1和T2时间与较低的患者报告的结果相关。损伤后30天内进行的ACLR在胫骨区域的T1 - rho时间显著缩短，修复治疗的外侧半月板撕裂比切除治疗的T1 - rho时间显著缩短。结论：延长放松时间在多个区域显示损伤如何影响整个关节后，前交叉韧带撕裂。在未受伤的膝关节中观察到的变化可能是由康复期间负荷增加引起的，特别是在髌股关节软骨和股骨远端。胫骨区域放松时间可预测患者6个月时的症状。这些相同的区域在受伤后30天就会受到手术时机的影响，但这可能部分反映了术前损伤的严重程度和半月板撕裂治疗的选择。
Background: Quantitative magnetic resonance (qMR) can be used to measure macromolecules in tissues and is a potential method of observing early cartilage changes in the development of posttraumatic osteoarthritis.Hypothesis/Purpose: We hypothesized that specific patient and surgical factors affecting cartilage matrix composition after anterior cruciate ligament (ACL) reconstruction (ACLR) can be detected using T1 rho and T2 relaxation times. Our purpose was to demonstrate this ability in a multicenter feasibility study.Study Design: Case series; Level of evidence, 4.Methods: A total of 54 patients who underwent ACLR underwent bilateral MRI at baseline before surgery and 6 months postoperatively. Operative findings were recorded. T1 rho and T2 relaxation times were calculated for 6 cartilage regions: the medial femur, lateral femur, medial tibia, lateral tibia, patella, and trochlea. A paired t test compared relaxation times at baseline and 6 months, univariate regression identified regions that influenced patient-reported outcome measures, and analysis of covariance was used to determine the surgical factors that resulted in elevated relaxation times at 6 months.Results: The injured knee had significantly prolonged T1 rho and T2 relaxation times in the tibiofemoral compartment at baseline and 6 months but had shorter values in the patellofemoral compartment compared with the uninjured knee. Prolonged T1 rho and T2 times at 6 months were noted for both the injured and uninjured knees. At 6 months, prolongation of T1 rho and T2 times in the tibial region was associated with lower patient-reported outcome measures. ACLR performed within 30 days of injury had significantly shorter T1 rho times in the tibial regions, and lateral meniscal tears treated with repair had significantly shorter T1 rho times than those treated with excision.Conclusion: Prolonged relaxation times in multiple regions demonstrate how the injury affects the entire joint after an ACL tear. Changes observed in the uninjured knee may be caused by increased loading during rehabilitation, especially in the patellofemoral articular cartilage and distal femur. Relaxation times in the tibial regions may be predictive of patient symptoms at 6 months. These same regions are affected by surgical timing as early as 30 days after injury, but this may partially be reflective of the severity of the preoperative injury and the choice of treatment of meniscal tears.