Longitudinal Investigation of in Vivo Tibiofemoral Kinematics, Cartilage Contact, and Cartilage Composition Prior to and Following Anterior Cruciate Ligament Reconstruction

Links

Abstract

Anterior cruciate ligament reconstructions (ACLR) are typically successful at restoring knee stability and returning patients to previous levels of activity. However, long-term outcomes of ACLR are concerning given that 10-15 years post-surgery >50% of patients exhibit signs of osteoarthritis. It has been theorized that the high rate of osteoarthritis in ACLR knees is partially due to residual abnormal knee mechanics that exist following surgery. Indeed, previous studies have observed abnormal kinematics and cartilage contact patterns in ACLR knees. However, there is currently limited evidence of a direct link between abnormal knee mechanics and cartilage degeneration in this population. Thus, the first primary objective of this thesis was to investigate the link between abnormal knee mechanics and biomarkers of cartilage degeneration through a combination of static, dynamic, and quantitative (i.e. mcDESPOT) magnetic resonance imaging. The second primary objective was to then assess the contribution of ACLR surgical factors to abnormal post-operative knee mechanics. We first investigated the link between mcDESPOT relaxation parameters and cartilage material properties to further validate using the mcDESPOT sequence to track changes in cartilage composition. We then investigated longitudinal changes in tibiofemoral kinematics, cartilage contact, and cartilage composition in ACLR knees. We determined that, within the medial tibial plateau, reductions in the fraction of water bound to proteoglycan were correlated to increased cartilage contact. This indicated that restoring normative knee mechanics is critical to mitigate the risk of cartilage degeneration in ACLR knees. Through the use of experimental and computational modeling methods, we then determined that non-anatomic ACL graft tunnel placement can lead to abnormal kinematics and cartilage loading during functional movement. We also observed that ACL graft stiffness and initial tension may contribute to abnormal knee mechanics. However, further work is needed to assess the relative contribution of each surgical factor to post-operative knee mechanics. Finally, we confirmed that the semi-automated algorithm used to segment articular cartilage, in this thesis, produced accurate and repeatable measures of cartilage thickness. We conclude that optimal graft tunnel placement is critical to restore normative knee mechanics, and, thus, to mitigate the risk of early osteoarthritis development in ACLR knees.

Cited Works (18)

Year	Entry
1968	Maroudas A. Physicochemical properties of cartilage in the light of ion exchange theory. Biophys J. May 1968;8(5):575-595.
1990	Holmes MH, Mow VC. The nonlinear characteristics of soft gels and hydrated connective tissues in ultrafiltration. J Biomech. 1990;23(11):1145-1156.
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.
1997	Ateshian GA, Warden W, Kim JJ, Grelsamer RP, Mow VC. Finite deformation biphasic material properties of bovine articular cartilage from confined compression experiments. J Biomech. November–December 1997;30:1157.
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.
2006	Shelburne KB, Torry MR, Pandy MG. Contributions of muscles, ligaments, and the ground-reaction force to tibiofemoral joint loading during normal gait. J Orthop Res. October 2006;24(10):1983-1990.
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.
2016	Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. June 2016;15(2):155-163.
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.
2008	Schileo E, Dall’Ara E, Taddei F, Malandrino A, Schotkamp T, Baleani M, Viceconti M. An accurate estimation of bone density improves the accuracy of subject-specific finite element models. J Biomech. August 7, 2008;41(11):2483-2491.
2008	Lawrence RC, Felson DT, Helmick CG, Arnold LM, Choi H, Deyo RA, Gabriel S, Hirsch R, Hochberg MC, Hunder GG, Jordan JM, Katz JN, Kremers HM, Wolfe F; National Arthritis Data Workgroup. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: part II. Arthritis Rheum. January 2008;58(1):26-35.
2006	Andriacchi TP, Briant PL, Bevill SL, Koo S. Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res. January 2006;442:39-44.
2006	Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech. 2006;39(16):2943-2950.
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.
2006	Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. NeuroImage. July 1, 2006;31(3):1116-1128.
1999	Cohen ZA, McCarthy DM, Kwak SD, Legrand P, Fogarasi F, Ciaccio EJ, Ateshian GA. Knee cartilage topography, thickness, and contact areas from MRI: in-vitro calibration and in-vivo measurements. Osteoarthritis Cartilage. January 1999;7(1):95-109.
1994	Setton LA, Mow VC, Müller FJ, Pita JC, Howell DS. Mechanical properties of canine articular cartilage are significantly altered following transection of the anterior cruciate ligament. J Orthop Res. July 1994;12(4):451-463.
2013	Gerus P, Sartori M, Besier TF, Fregly BJ, Delp SL, Banks SA, Pandy MG, D'Lima DD, Lloyd DG. Subject-specific knee joint geometry improves predictions of medial tibiofemoral contact forces. J Biomech. November 15, 2013;46(16):2778-2786.