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Cartilage Status in Relation to Return to Sports After Anterior Cruciate Ligament Reconstruction


Ans Van Ginckel, PT, MSc
BELGIUM

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Cartilage Status in Relation to Return to Sports After Anterior Cruciate Ligament Reconstruction

Ans Van Ginckel, PT, MSc, BELGIUM Peter Verdonk, MD, PhD, BELGIUM Jan M. K. Victor, MD, PhD, BELGIUM Erik Witvrouw, PT, PhD, BELGIUM

Ghent University, Ghent, BELGIUM

2013 Congress   Paper Abstract   2013 Congress   Not yet rated

 

Anatomic Location

Knee

Anatomic Structure

Cartilage Ligaments

Diagnosis / Condition

Osteoarthritis Instability

Diagnosis Method

MRI

Sports Medicine

Basic Science Preventative Sports Medicine Practice Management Rehabilition / Physical Therapy Sport Specific Injuries Biomechanics

Treatment / Technique

Arthroscopy Autograft Repair / Reconstruction

Cartilage

Cartilage Injuries

Ligaments

ACL

Summary: Six months after isolated ACL reconstruction, knee cartilage shows inferior quality and diminished cushioning properties that are proposed being a potential danger in case of full return to sports,especially in patients who received early surgery.

Background

Osteoarthritis following ACL reconstruction receives much attention in orthopedic science. ACL reconstruction is related to increased joint fluid volumes, bone marrow edema, and cartilage biochemical and morphological changes believed to cause precarious joint conditions. These joint conditions may not be able to adequately counter the imposed loads during sports.

Hypothesis

At 6 months after surgery, knee cartilage displays inferior quality in ACL-reconstructed patients when compared with controls. This inferior quality is influenced by timing of return to sport and/or by timing of surgery.

Study Design:
Case-control

Methods

At 6 months after surgery, 15 patients treated with isolated ACL reconstruction (hamstrings autografts) were compared to 15 matched-controls. In all subjects, a 3T MRI cartilage evaluation was performed entailing morphology (3D volume/thickness), biochemical composition (T2/T2star mapping), function (following a 30-minute run: in vivo deformation including recovery). Non-parametric statistics were executed reporting medians(95% CI).

Results

No volume and thickness between-groups differences existed. In patients, medial femur T2 was higher (45.44 ms (40.64,51.49) vs 37.19 ms (34.67,40.39), P=0.028), whereas T2star was lower in the medial femur (21.81 ms (19.89, 22.74) vs 24.29 ms (22.70,26.26), P=0.004), medial tibia (13.81 ms (10.26,16.78) vs 17.98 ms (15.95,18.90), P=0.016) and lateral tibia (14.69 ms (11.71,16.72) vs 18.62 ms (17.85,22.04), P<0.001). After a 30-minute run, patients showed diminished recovery at 30 minutes post-exercise in the medial femur (-1.60% (-4.82,-0.13) vs 0.01% (-0.34,1.23), P=0.040), and at 30 (-3.76% (-9.29,-1.78) vs 0.04% (-1.52,-0.72), P=0.004) and 45 minutes post-exercise (-1.86% (-4.66,-0.40) vs 0.43% (-0.91,0.77), P=0.024) in the lateral tibia. Eight patients returned to sports at 6 months or earlier. Return before 5 months (3/8 patients) was associated with increased cartilage morphology, deformation and delayed recovery whereas surgery within 10 weeks (9/15 patients) was associated with delayed cartilage recovery following running. Median surgical delay was 10 weeks(5-17).

Conclusions

At 6 months after surgery, cartilage in patients with ACL-reconstruction shows diminished quality and in vivo resiliency compared with controls. Caution is advised in an early return to sports especially when dealing with patients who received prompt surgery. Possibly, high impacts on this qualitatively diminished cartilage might play a role in the development of OA in ACL reconstruction. Replication in larger samples and follow-up are warranted.