Cartilage Subsurface Changes to Magnetic Resonance Imaging UTE-T2*2 Years After Anterior Cruciate Ligament Reconstruction Correlate With Walking Mechanics Associated With Knee Osteoarthritis
Cartilage Subsurface Changes to Magnetic Resonance Imaging UTE-T2*2 Years After Anterior Cruciate Ligament Reconstruction Correlate With Walking Mechanics Associated With Knee Osteoarthritis
复制标题
膝关节骨关节炎患者前十字韧带重建术后2年软骨表面下磁共振成像改变与行走机制的相关性
DOI：
10.1177/0363546517743969
复制
发表时间：
2018-03-01
影响因子：
4.8
通讯作者：
Chu, Constance R.
中科院分区：
文献类型：
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作者：
Titchenal, Matthew R.;Williams, Ashley A.;Chu, Constance R.
背景：前交叉韧带(ACL)损伤增加了创伤性膝骨性关节炎(OA)的风险。超短回声时间增强T2*(UTE-T2*)定量成像显示了早期发现ACL重建(ACLR)后潜在可逆的表层下软骨异常的希望，但还需要对照已建立的膝关节内收力矩(KAM)和机械对齐等OA风险的临床指标进行进一步验证。假设：ACLR后2年膝关节内侧软骨UTE-T2*值升高与行走时内翻对齐和KAM升高相关。研究设计：队列研究(诊断)；证据水平，2。方法：20名患者(平均年龄33.1±10.5岁；11名女性)ACLR患者在接受3.0T膝关节磁共振成像(MRI)、X线片和步态分析2年后，测量机械排列，计算步行时的KAM，并生成UTE-T2*图。用线性回归分析KAM的机械轴和第一、第二峰(分别为KAM1和KAM2)与股骨中央、后内侧髁(分别为cMFC和pMFC)和胫骨中央内侧平台(CMTP)的UTE-T2*值之间的相关性。采用Mann-Whitney U检验和标准t检验，对前交叉韧带重建组和14例未损伤组(平均年龄30.9±8.9岁，女性6例)的UTE-T2*值进行比较。结果：在形态MRI上，前交叉韧带重建组膝关节中央承重内侧室软骨完整。重建前交叉韧带的膝关节的cMFC和pMFC的平均UTE-T2*值均高于未损伤的膝关节(分别为P=0.003和P=0.012)。在前交叉韧带重建的膝关节中，cMFC软骨的UTE-T2*值与内翻排列的增加呈正相关(R=0.568)。前交叉韧带重建组膝关节内侧软骨UUT-T2*值升高与KAM1(R=0.452和R=0.463)、KAM2(R=0.465和R=0.764)和PMFC软骨KAM2(R=0.602)相关。结论：膝关节内侧软骨深部UUT-T2*值升高与膝关节内侧骨关节炎风险增加的两项临床指标相关。这些结果支持了MRI UTE-T2*在早期诊断软骨下异常方面的临床应用。需要对更大的队列进行纵向随访，以确定UTET2*对创伤后骨性关节炎的预测和分期潜力。
Background: Anterior cruciate ligament (ACL) injury increases risk for posttraumatic knee osteoarthritis (OA). Quantitative ultra short echo time enhanced T2* (UTE-T2*) mapping shows promise for early detection of potentially reversible subsurface cartilage abnormalities after ACL reconstruction (ACLR) but needs further validation against established clinical metrics of OA risk such as knee adduction moment (KAM) and mechanical alignment.Hypothesis: Elevated UTE-T2* values in medial knee cartilage 2 years after ACLR correlate with varus alignment and higher KAM during walking.Study Design: Cohort study (diagnosis); Level of evidence, 2.Methods: Twenty patients (mean age, 33.1 10.5 years; 11 female) 2 years after ACLR underwent 3.0-T knee magnetic resonance imaging (MRI), radiography, and gait analysis, after which mechanical alignment was measured, KAM during walking was calculated, and UTE-T2* maps were generated. The mechanical axis and the first and second peaks of KAM (KAM1 and KAM2, respectively) were tested using linear regressions for correlations with deep UTE-T2* values in the central and posterior medial femoral condyle (cMFC and pMFC, respectively) and central medial tibial plateau (cMTP). UTE-T2* values from ACL-reconstructed patients were additionally compared with those of 14 uninjured participants (mean age, 30.9 +/- 8.9 years; 6 female) using Mann-Whitney U and standard t tests.Results: Central weightbearing medial compartment cartilage of ACL-reconstructed knees was intact on morphological MRI. Mean UTE-T2* values were elevated in both the cMFC and pMFC of ACL-reconstructed knees compared with those of uninjured knees (P = .003 and P = .012, respectively). In ACL-reconstructed knees, UTE-T2* values of cMFC cartilage positively correlated with increasing varus alignment (R = 0.568). Higher UTE-T2* values in cMFC and cMTP cartilage of ACL-reconstructed knees also correlated with greater KAM1 (R = 0.452 and R = 0.463, respectively) and KAM2 (R = 0.465 and R = 0.764, respectively) and with KAM2 in pMFC cartilage (R = 0.602).Conclusion: Elevated deep UTE-T2* values of medial knee cartilage 2 years after ACLR correlate with 2 clinical markers of increased risk of medial knee OA. These results support the clinical utility of MRI UTE-T2* for early diagnosis of subsurface cartilage abnormalities. Longitudinal follow-up of larger cohorts is needed to determine the predictive and staging potential of UTET2* for posttraumatic OA.