A Comprehensive Framework to Evaluate the Effects of Anterior Cruciate Ligament Injury and Reconstruction on Graft and Cartilage Status through the Analysis of MRI T2 Relaxation Time and Knee Laxity: A Pilot Study

Abstract

Background: Anterior cruciate ligament (ACL) tear represents a common orthopedic traumatic issue that often leads to an early development of osteoarthritis. To improve the diagnostic and prognostic techniques involved in the assessment of the joint after the trauma and during the healing process, the present work proposes a multi-parametric approach that aims to investigate the relationship between joint function and soft tissue status before and after ACL reconstruction. Methods: Thirteen consecutive patients who underwent ACL reconstruction were preliminarily enrolled in this study. Joint laxity assessment as well as magnetic resonance imaging with T2 mapping were performed in the pre-operative stage, at four and 18 months after surgery to acquire objective information to correlate knee function and soft tissue condition. Results: Correlations were found between graft and cartilage T2 signal, suggesting an interplay between these tissues within the knee joint. Moreover, graft maturation resulted in being connected to joint laxity, as underlined by the correlation between the graft T2 signal and the temporal evolution of knee function. Conclusions: This preliminary study represents a step forward in assessing the effects of ACL graft maturation on knee biomechanics, and vice versa. The presented integrated framework underlines the possibility to quantitatively assess the impact of ACL reconstruction on trauma recovery and cartilage homeostasis. Moreover, the reported findings—despite the preliminary nature of the clinical impacts—evidence the possibility of monitoring the surgery outcomes using a multi-parametric prognostic investigation tool.

Assessment of articular cartilage of ankle joint in stable and unstable unilateral weber type-B/SER-type ankle fractures shortly after trauma using T2 relaxation time

“…Only few publications have assessed knee articular cartilage using qMRI shortly after anterior cruciate ligament (ACL) injuries. [49][50][51][52][53] Similar to our findings, lower T2 values have been observed shortly after ACL injury by Casula et al 49 in the knee cartilage. Studies by Marchiori et al 50 and Zhong et al 51 describe T2 relaxation time of knee cartilage after trauma, before ACL repair, but do not specify the time between the trauma and qMRI measurements.…”

Multiscale Correlations between Joint and Tissue-Specific Biomechanics and Anatomy in Postmortem Ovine Stifles

“…We hypothesize that adjusting these measurements with respect to the body weight may lead to improved correlation strengths, as reported in an earlier study [40]. These results corroborate with few earlier studies [41, 42] that have suggested possible correlations between the T 2 * relaxation time for specific tissues like cartilage and meniscus and joint health in diseased conditions such as osteoarthritis or ACL related injuries.…”

Early MRI-based quantitative outcomes are associated with a positive functional performance trajectory from 6 to 24 months post-ACL surgery

“…In previous research, Biercevicz et al found that ACL graft volume and median signal intensity acquired from a T 1 ‐weighted sequence were associated with single‐leg hop test performance at 3‐ and 5‐year follow‐ups, as well as Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life, sport/function, pain, and symptom sub‐scores at 5‐year follow up, when the MR images were acquired at the same timepoints [4]. Marchiori et al found that T 2 relaxation time of the graft was correlated with arthrometric knee laxity at 4‐ and 18‐month follow up [28]. Once again, the T 2 relaxation time and arthrometric knee laxity were measured at the same timepoints, rather than between timepoints.…”

“…Previous investigations have suggested that the quantitative graft changes observed on MRI post‐ACL reconstruction (ACLR) are related to contemporaneous clinical, functional, and patient‐reported outcomes [4, 20, 23, 28, 34, 39, 44]. While these studies highlight the utility of qMRI outcomes in tracking patients’ response to ACL surgery, there is a lack of evidence as to whether qMRI measures of the ACL can be used to predict future clinical, functional, and patient‐reported outcomes after ACL surgery.…”