Assessment of Cartilage Contact and Early Degeneration Following ACL Reconstruction

While ACL-reconstruction following injury restores knee stability and allows patients to return to activity, rates of early osteoarthritis post-surgery are high, with some reports as high as 80% of patients showing degeneration within 20 years. Many believe that early OA is due to residual abnormalities in joint mechanics after ACL-reconstruction. Proving a direct link between altered mechanics and cartilage degeneration, however, requires an imaging modality which can both measure in vivo joint motion with high accuracy and detect early degeneration. This thesis uses a new dynamic imaging sequence to measure in vivo joint motion and advanced quantitative MR sequences to assess cartilage composition to investigate potential links between cartilage loading and degeneration following ACL-reconstruction. We first validated the novel dynamic MR sequence, termed SPGR-VIPR, showing it is able to track tibiofemoral rotations and translations with precisions less than 0.8° and 0.5 mm, respectively. We then confirmed that healthy subjects exhibit bilateral symmetry in tibiofemoral kinematics during active knee flexion, which supports the use of the contralateral knee as a control in ACL-reconstructed knees. We then performed the dynamic imaging protocol on patients who previously had unilateral, primary ACLreconstruction 1-3 years prior. We found that an inertial loading paradigm elicited significant asymmetries in knee kinematics, with the ACL-reconstructed knees exhibiting greater external tibial (~2°) and patellar (~1.3°) rotation during active flexion. These kinematic abnormalities lead to a shift in contact in both the medial and lateral tibial plateaus. The quantitative MR sequence, termed MC-DESPOT, also identified a significant decrease in proteoglycan-bound water metrics in both the medial and lateral tibial plateau, which may be indicative of early cartilage degeneration. We conclude that early biomarkers of osteoarthritis coincide with the time at which abnormal knee mechanics can be observed in ACL-reconstructed knees.

Year	Entry
2005	Guilak F, Hung CT. Physical regulation of cartilage metabolism. In: Mow VC, Huiskes R, eds. Basic Orthopaedic Biomechanics & Mechano-Biology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:259-300.
2008	Chaudhari AMW, Briant PL, Bevill SL, Koo S, Andriacchi TP. Knee kinematics, cartilage morphology, and osteoarthritis after ACL injury. Med Sci Sports Exer. February 2008;40(2):215-222.
2005	Andriacchi TP, Dyrby CO. Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech. February 2005;38(2):293-298.
1983	Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. May 1983;105(2):136-144.
1993	Söderkvist I, Wedin P-Å. Determining the movements of the skeleton using well-configured markers. J Biomech. December 1993;26(12):1473-1477.
1991	Clark JM. Variation of collagen fiber alignment in a joint surface: a scanning electron microscope study of the tibial plateau in dog, rabbit, and man. J Orthop Res. March 1991;9(2):246-257.
1999	Li G, Rudy TW, Sakane M, Kanamori A, Ma CB, Woo SL-Y. The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL. J Biomech. April 1999;32(4):395-400.
1964	Powell MJD. An efficient method for finding the minimum of a function of several variables without calculating derivatives. Comput J. 1964;7(2):155-162.
1995	Buschmann MD, Grodzinsky AJ. A molecular model of proteoglycan-associated electrostatic forces in cartilage mechanics. J Biomech Eng. May 1995;117(2):179-192.
1980	Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee: a study of normal and osteoarthrotic knee joints. Acta Orthop Scand. December 1980;51(5):871-879.
2004	Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. March 2004;32(3):447-457.
1995	Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage. December 1995;3(3):261-267.
2009	Andriacchi TP, Koo S, Scanlan SF. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. J Bone Joint Surg. February 2009;91A(suppl 1):95-101.
2006	Andriacchi TP, Mündermann A. The role of ambulatory mechanics in the initiation and progression of knee osteoarthritis. Curr Opin Rhuematol. September 2006;18(5):514-518.
1995	Wu G, Cavanagh PR. ISB recommendations for standardization in the reporting of kinematic data. J Biomech. 1995;28(10):1257-1261.
2007	Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. October 2007;35(10):1756-1769.
2003	Wong M, Carter DR. Articular cartilage functional histomorphology and mechanobiology: a research perspective. Bone. July 2003;33(1):1-13.
1998	Sheehan FT, Zajac FE, Drace JE. Using cine phase contrast magnetic resonance imaging to non-invasively study in vivo knee dynamics. J Biomech. January 1998;31(1):21-26.
2008	Elsaid KA, Fleming BC, Oksendahl HL, Machan JT, Fadale PD, Hulstyn MJ, Shalvoy R, Jay GD. Decreased lubricin concentrations and markers of joint inflammation in synovial fluids from patients with anterior cruciate ligament injury. Arthritis Rheum. June 2008;58(6):1707-1715.
1992	Lafortune MA, Cavanagh PR, Sommer HJ III, Kalenak A. Three-dimensional kinematics of the human knee during walking. J Biomech. April 1992;25(4):347-357.
2003	Tashman S, Anderst W. In-vivo measurement of dynamic joint motion using high speed biplane radiography and CT: application to canine ACL deficiency. J Biomech Eng. April 2003;125(2):238-245.

Year

Entry

2005

Guilak F, Hung CT. Physical regulation of cartilage metabolism. In: Mow VC, Huiskes R, eds. Basic Orthopaedic Biomechanics & Mechano-Biology. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005:259-300.

2008

Chaudhari AMW, Briant PL, Bevill SL, Koo S, Andriacchi TP. Knee kinematics, cartilage morphology, and osteoarthritis after ACL injury. Med Sci Sports Exer. February 2008;40(2):215-222.

2005

Andriacchi TP, Dyrby CO. Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech. February 2005;38(2):293-298.

1983

Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. May 1983;105(2):136-144.

1993

Söderkvist I, Wedin P-Å. Determining the movements of the skeleton using well-configured markers. J Biomech. December 1993;26(12):1473-1477.