Cartilage injury after acute, isolated anterior cruciate ligament tear

Immediate and longitudinal effect with clinical/MRI follow-up

Hollis G. Potter, Sapna K. Jain, Yan Ma, Brandon R. Black, Sebastian Fung, Leonard Lyman Stephen

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Background: Anterior cruciate ligament (ACL) tears have been implicated in the development of osteoarthritis. Limited data exist on longitudinal follow-up of isolated ACL injury.Hypotheses: All isolated ACL tears are associated with some degree of cartilage injury that will deteriorate over time. There is a threshold of magnetic resonance imaging (MRI)-detectable cartilage injury that will correlate with adverse change in subjective patient-reported outcome measures.Study Design: Cohort study, Level of evidence, 2.Methods: The authors conducted a prospective, observational analysis of 42 knees in 40 patients with acute, isolated ACL injury (14 treated nonoperatively, 28 by reconstruction) with imaging at the time of injury and yearly follow-up for a maximum of 11 years. Morphologic MRI and quantitative T2 mapping was performed with validated outcome measures.Results: All patients sustained chondral damage at initial injury. The adjusted risk of cartilage loss doubled from year 1 for the lateral compartment and medial femoral condyle (MFC) and tripled for the patella. By years 7 to 11, the risk for the lateral femoral condyle was 50 times baseline, 30 times for the patella, and 19 times for the MFC. There was increased risk of cartilage degeneration over the medial tibial plateau (MTP) (P =.047; odds ratio = 6.23; 95% confidence interval [CI], 1.03-37.90) and patella (P =.032; odds ratio = 4.88; 95% CI, 1.14-20.80) in nonsurgical patients compared with surgically treated patients. Size of the bone-marrow edema pattern was associated with cartilage degeneration from baseline to year 3 (P =.001 to.039). Each increase in the MFC Outerbridge score resulted in a 13-point decrease in the International Knee Documentation Committee subjective knee score (P =.0002). Each increase in the MTP resulted in a 2.4-point decrease in the activity rating scale (P =.002).Conclusion: All patients with acute, traumatic ACL disruption sustained a chondral injury at the time of initial impact with subsequent longitudinal chondral degradation in compartments unaffected by the initial "bone bruise," a process that is accelerated at 5 to 7 years' follow-up.

Original languageEnglish
Pages (from-to)276-285
Number of pages10
JournalAmerican Journal of Sports Medicine
Volume40
Issue number2
DOIs
Publication statusPublished - Feb 1 2012
Externally publishedYes

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Cartilage
Magnetic Resonance Imaging
Wounds and Injuries
Thigh
Patella
Bone and Bones
Knee
Odds Ratio
Confidence Intervals
Anterior Cruciate Ligament Injuries
Contusions
Anterior Cruciate Ligament
Osteoarthritis
Documentation
Edema
Cohort Studies
Bone Marrow
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Orthopedics and Sports Medicine
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Cartilage injury after acute, isolated anterior cruciate ligament tear : Immediate and longitudinal effect with clinical/MRI follow-up. / Potter, Hollis G.; Jain, Sapna K.; Ma, Yan; Black, Brandon R.; Fung, Sebastian; Lyman Stephen, Leonard.

In: American Journal of Sports Medicine, Vol. 40, No. 2, 01.02.2012, p. 276-285.

Research output: Contribution to journalArticle

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abstract = "Background: Anterior cruciate ligament (ACL) tears have been implicated in the development of osteoarthritis. Limited data exist on longitudinal follow-up of isolated ACL injury.Hypotheses: All isolated ACL tears are associated with some degree of cartilage injury that will deteriorate over time. There is a threshold of magnetic resonance imaging (MRI)-detectable cartilage injury that will correlate with adverse change in subjective patient-reported outcome measures.Study Design: Cohort study, Level of evidence, 2.Methods: The authors conducted a prospective, observational analysis of 42 knees in 40 patients with acute, isolated ACL injury (14 treated nonoperatively, 28 by reconstruction) with imaging at the time of injury and yearly follow-up for a maximum of 11 years. Morphologic MRI and quantitative T2 mapping was performed with validated outcome measures.Results: All patients sustained chondral damage at initial injury. The adjusted risk of cartilage loss doubled from year 1 for the lateral compartment and medial femoral condyle (MFC) and tripled for the patella. By years 7 to 11, the risk for the lateral femoral condyle was 50 times baseline, 30 times for the patella, and 19 times for the MFC. There was increased risk of cartilage degeneration over the medial tibial plateau (MTP) (P =.047; odds ratio = 6.23; 95{\%} confidence interval [CI], 1.03-37.90) and patella (P =.032; odds ratio = 4.88; 95{\%} CI, 1.14-20.80) in nonsurgical patients compared with surgically treated patients. Size of the bone-marrow edema pattern was associated with cartilage degeneration from baseline to year 3 (P =.001 to.039). Each increase in the MFC Outerbridge score resulted in a 13-point decrease in the International Knee Documentation Committee subjective knee score (P =.0002). Each increase in the MTP resulted in a 2.4-point decrease in the activity rating scale (P =.002).Conclusion: All patients with acute, traumatic ACL disruption sustained a chondral injury at the time of initial impact with subsequent longitudinal chondral degradation in compartments unaffected by the initial {"}bone bruise,{"} a process that is accelerated at 5 to 7 years' follow-up.",
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T1 - Cartilage injury after acute, isolated anterior cruciate ligament tear

T2 - Immediate and longitudinal effect with clinical/MRI follow-up

AU - Potter, Hollis G.

AU - Jain, Sapna K.

AU - Ma, Yan

AU - Black, Brandon R.

AU - Fung, Sebastian

AU - Lyman Stephen, Leonard

PY - 2012/2/1

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N2 - Background: Anterior cruciate ligament (ACL) tears have been implicated in the development of osteoarthritis. Limited data exist on longitudinal follow-up of isolated ACL injury.Hypotheses: All isolated ACL tears are associated with some degree of cartilage injury that will deteriorate over time. There is a threshold of magnetic resonance imaging (MRI)-detectable cartilage injury that will correlate with adverse change in subjective patient-reported outcome measures.Study Design: Cohort study, Level of evidence, 2.Methods: The authors conducted a prospective, observational analysis of 42 knees in 40 patients with acute, isolated ACL injury (14 treated nonoperatively, 28 by reconstruction) with imaging at the time of injury and yearly follow-up for a maximum of 11 years. Morphologic MRI and quantitative T2 mapping was performed with validated outcome measures.Results: All patients sustained chondral damage at initial injury. The adjusted risk of cartilage loss doubled from year 1 for the lateral compartment and medial femoral condyle (MFC) and tripled for the patella. By years 7 to 11, the risk for the lateral femoral condyle was 50 times baseline, 30 times for the patella, and 19 times for the MFC. There was increased risk of cartilage degeneration over the medial tibial plateau (MTP) (P =.047; odds ratio = 6.23; 95% confidence interval [CI], 1.03-37.90) and patella (P =.032; odds ratio = 4.88; 95% CI, 1.14-20.80) in nonsurgical patients compared with surgically treated patients. Size of the bone-marrow edema pattern was associated with cartilage degeneration from baseline to year 3 (P =.001 to.039). Each increase in the MFC Outerbridge score resulted in a 13-point decrease in the International Knee Documentation Committee subjective knee score (P =.0002). Each increase in the MTP resulted in a 2.4-point decrease in the activity rating scale (P =.002).Conclusion: All patients with acute, traumatic ACL disruption sustained a chondral injury at the time of initial impact with subsequent longitudinal chondral degradation in compartments unaffected by the initial "bone bruise," a process that is accelerated at 5 to 7 years' follow-up.

AB - Background: Anterior cruciate ligament (ACL) tears have been implicated in the development of osteoarthritis. Limited data exist on longitudinal follow-up of isolated ACL injury.Hypotheses: All isolated ACL tears are associated with some degree of cartilage injury that will deteriorate over time. There is a threshold of magnetic resonance imaging (MRI)-detectable cartilage injury that will correlate with adverse change in subjective patient-reported outcome measures.Study Design: Cohort study, Level of evidence, 2.Methods: The authors conducted a prospective, observational analysis of 42 knees in 40 patients with acute, isolated ACL injury (14 treated nonoperatively, 28 by reconstruction) with imaging at the time of injury and yearly follow-up for a maximum of 11 years. Morphologic MRI and quantitative T2 mapping was performed with validated outcome measures.Results: All patients sustained chondral damage at initial injury. The adjusted risk of cartilage loss doubled from year 1 for the lateral compartment and medial femoral condyle (MFC) and tripled for the patella. By years 7 to 11, the risk for the lateral femoral condyle was 50 times baseline, 30 times for the patella, and 19 times for the MFC. There was increased risk of cartilage degeneration over the medial tibial plateau (MTP) (P =.047; odds ratio = 6.23; 95% confidence interval [CI], 1.03-37.90) and patella (P =.032; odds ratio = 4.88; 95% CI, 1.14-20.80) in nonsurgical patients compared with surgically treated patients. Size of the bone-marrow edema pattern was associated with cartilage degeneration from baseline to year 3 (P =.001 to.039). Each increase in the MFC Outerbridge score resulted in a 13-point decrease in the International Knee Documentation Committee subjective knee score (P =.0002). Each increase in the MTP resulted in a 2.4-point decrease in the activity rating scale (P =.002).Conclusion: All patients with acute, traumatic ACL disruption sustained a chondral injury at the time of initial impact with subsequent longitudinal chondral degradation in compartments unaffected by the initial "bone bruise," a process that is accelerated at 5 to 7 years' follow-up.

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