Brian Pietrosimone1,2,3, Steven J Pfeiffer4,5, Matthew S Harkey6, Kyle Wallace4, Christian Hunt4, J Troy Blackburn4,5,7, Randy Schmitz8, David Lalush9, Daniel Nissman10, Jeffrey T Spang7. 1. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA. brian@unc.edu. 2. Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA. brian@unc.edu. 3. Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA. brian@unc.edu. 4. Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, CB# 8700, 209 Fetzer Hall South Road, Chapel Hill, NC, 27599, USA. 5. Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Fetzer Hall 209 South Road, Chapel Hill, NC, 27599, USA. 6. Division of Rheumatology, Tufts Medical Center, 800 Washington Street, South Building, 3rd Floor, Boston, MA, 02111, USA. 7. Department of Orthopaedics, University of North Carolina at Chapel Hill, 102 Mason Farm Rd # 2, Chapel Hill, NC, 27599, USA. 8. Department of Kinesiology, University of North Carolina at Greensboro, Coleman Building, 1408 Walker Avenue, Greensboro, NC, 27402, USA. 9. Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, 333 S Columbia St, Raleigh, NC, 27514, USA. 10. Department of Radiology, University of North Carolina at Chapel Hill, 101 Manning Dr # 2, Chapel Hill, NC, 27599, USA.
Abstract
PURPOSE: Quadriceps weakness following anterior cruciate ligament reconstruction (ACLR) is linked to decreased patient-reported function, altered lower extremity biomechanics and tibiofemoral joint space narrowing. It remains unknown if quadriceps weakness is associated with early deleterious changes to femoral cartilage composition that are suggestive of posttraumatic osteoarthritis development. The purpose of the cross-sectional study was to determine if quadriceps strength was associated with T1ρ relaxation times, a marker of proteoglycan density, of the articular cartilage in the medial and lateral femoral condyles 6 months following ACLR. It is hypothesized that individuals with weaker quadriceps would demonstrate lesser proteoglycan density. METHODS: Twenty-seven individuals (15 females, 12 males) with a patellar tendon autograft ACLR underwent isometric quadriceps strength assessments in 90°of knee flexion during a 6-month follow-up exam. Magnetic resonance images (MRI) were collected bilaterally and voxel by voxel T1ρ relaxation times were calculated using a five-image sequence and a monoexponential equation. Following image registration, the articular cartilage for the weight-bearing surfaces of the medial and lateral femoral condyles (MFC and LFC) were manually segmented and further sub-sectioned into posterior, central and anterior regions of interest (ROI) based on the corresponding meniscal anatomy viewed in the sagittal plane. Univariate linear regression models were used to determine the association between quadriceps strength and T1ρ relaxation times in the entire weight-bearing MFC and LFC, as well as the ROI in each respective limb. RESULTS: Lesser quadriceps strength was significantly associated with greater T1ρ relaxation times in the entire weight-bearing MFC (R2 = 0.14, P = 0.05) and the anterior-MFC ROI (R2 = 0.22, P = 0.02) of the ACLR limb. A post hoc analysis found lesser strength and greater T1ρ relaxation times were significantly associated in a subsection of participants (n = 18) without a concomitant medial tibiofemoral compartment meniscal or chondral injury in the entire weight-bearing MFC, as well as anterior-MFC and central-MFC ROI of the ACLR and uninjured limb. CONCLUSIONS: The association between weaker quadriceps and greater T1ρ relaxation times in the MFC suggests deficits in lower extremity muscle strength may be related to cartilage composition as early as 6 months following ACLR. Maximizing quadriceps strength in the first 6 months following ACLR may be critical for promoting cartilage health early following ACLR. LEVEL OF EVIDENCE: Prognostic level 1.
PURPOSE:Quadriceps weakness following anterior cruciate ligament reconstruction (ACLR) is linked to decreased patient-reported function, altered lower extremity biomechanics and tibiofemoral joint space narrowing. It remains unknown if quadriceps weakness is associated with early deleterious changes to femoral cartilage composition that are suggestive of posttraumatic osteoarthritis development. The purpose of the cross-sectional study was to determine if quadriceps strength was associated with T1ρ relaxation times, a marker of proteoglycan density, of the articular cartilage in the medial and lateral femoral condyles 6 months following ACLR. It is hypothesized that individuals with weaker quadriceps would demonstrate lesser proteoglycan density. METHODS: Twenty-seven individuals (15 females, 12 males) with a patellar tendon autograft ACLR underwent isometric quadriceps strength assessments in 90°of knee flexion during a 6-month follow-up exam. Magnetic resonance images (MRI) were collected bilaterally and voxel by voxel T1ρ relaxation times were calculated using a five-image sequence and a monoexponential equation. Following image registration, the articular cartilage for the weight-bearing surfaces of the medial and lateral femoral condyles (MFC and LFC) were manually segmented and further sub-sectioned into posterior, central and anterior regions of interest (ROI) based on the corresponding meniscal anatomy viewed in the sagittal plane. Univariate linear regression models were used to determine the association between quadriceps strength and T1ρ relaxation times in the entire weight-bearing MFC and LFC, as well as the ROI in each respective limb. RESULTS:Lesser quadriceps strength was significantly associated with greater T1ρ relaxation times in the entire weight-bearing MFC (R2 = 0.14, P = 0.05) and the anterior-MFC ROI (R2 = 0.22, P = 0.02) of the ACLR limb. A post hoc analysis found lesser strength and greater T1ρ relaxation times were significantly associated in a subsection of participants (n = 18) without a concomitant medial tibiofemoral compartment meniscal or chondral injury in the entire weight-bearing MFC, as well as anterior-MFC and central-MFC ROI of the ACLR and uninjured limb. CONCLUSIONS: The association between weaker quadriceps and greater T1ρ relaxation times in the MFC suggests deficits in lower extremity muscle strength may be related to cartilage composition as early as 6 months following ACLR. Maximizing quadriceps strength in the first 6 months following ACLR may be critical for promoting cartilage health early following ACLR. LEVEL OF EVIDENCE: Prognostic level 1.
Authors: Christopher L Mendias; Elizabeth R Sibilsky Enselman; Adam M Olszewski; Jonathan P Gumucio; Daniel L Edon; Maxwell A Konnaris; James E Carpenter; Tariq M Awan; Jon A Jacobson; Joel J Gagnier; Ariel L Barkan; Asheesh Bedi Journal: Am J Sports Med Date: 2020-05-26 Impact factor: 6.202
Authors: Anthony Hipsley; Michelle Hall; David J Saxby; Kim L Bennell; Xinyang Wang; Adam L Bryant Journal: Knee Surg Sports Traumatol Arthrosc Date: 2022-01-07 Impact factor: 4.342
Authors: Alyssa Evans-Pickett; Caroline Lisee; W Zachary Horton; David Lalush; Daniel Nissman; J Troy Blackburn; Jeffrey T Spang; Brian Pietrosimone Journal: Med Sci Sports Exerc Date: 2022-06-11
Authors: Caroline Brunst; Matthew P Ithurburn; Andrew M Zbojniewicz; Mark V Paterno; Laura C Schmitt Journal: J Orthop Res Date: 2021-04-08 Impact factor: 3.494
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Authors: Steven J Pfeiffer; Jeffrey T Spang; Daniel Nissman; David Lalush; Kyle Wallace; Matthew S Harkey; Laura S Pietrosimone; Darin Padua; Troy Blackburn; Brian Pietrosimone Journal: Orthop J Sports Med Date: 2021-07-21