ACL Graft Signal Characteristics Measured by Quantitative MRI Are Significantly Correlated with Patient Reported Outcomes Two-Years after Hamstring Autograft ACL Reconstruction
Objectives: Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization. Collagen within the ACL graft becomes organized along the long-axis of the ligament and the proteoglycan content increases. Quantitative imaging...
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Published in | Orthopaedic journal of sports medicine Vol. 7; no. 7_suppl5; p. 2325967119 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Los Angeles, CA
SAGE Publications
29.07.2019
Sage Publications Ltd |
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Abstract | Objectives:
Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization. Collagen within the ACL graft becomes organized along the long-axis of the ligament and the proteoglycan content increases. Quantitative imaging sequences, specifically T2 and T1rho, allow for a non-invasive assessment of collagen orientation and proteoglycan content, respectively. The purpose of this study was to investigate the longitudinal progression of T2 and T1rho relaxation times of the graft after ACL reconstruction and the relationship between these quantitative imaging markers and patient-reported outcome measures. We hypothesized that T2 and T1rho would decrease significantly over time, reflecting improved collagen organization and ncreased proteoglycan content, and that T2 and T1rho relaxation times would be inversely correlated with Knee Osteoarthritis Outcome Scores (KOOS).
Methods:
Thirty-two patients (mean age 29.4±8.2 years, 12 females) were followed prospectively after arthroscopic ACL reconstruction with hamstring autograft. Patients provided informed consent and all procedures were IRB-approved. Exclusion criteria included allograft reconstruction, other ligamentous injury, meniscal tear requiring repair, prior knee surgery, or history of arthritis. Post-operative MR imaging was obtained for 31 patients at 6 months, 30 patients at 12 months, 26 patients at 24 months, and 23 patients at 36 months after surgery. T2 and T1rho relaxation times were simultaneously acquired with a combined 3D sagittal sequence using a 3 T MR system (GE Healthcare) with a 1Tx/8Rx knee coil. The intra-articular ACL graft was identified on a fat-suppressed sagittal high-resolution 3D fast spin echo images and manually segmented. The T2 and T1rho relaxation times for the graft were recorded. Patients completed the KOOS at each imaging time point. Repeated measures analysis of variance (ANOVA) tests with Tukey corrections were used to compare T2 and T1rho relaxation times between time points. The relationship between KOOS and T2 and T1rho values at 2 years post-operative was investigated with Spearman’s rank correlation. Significance was defined as p<0.05.
Results:
The T2 relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001,) and 36 months (p<0.001) after ACL reconstruction, as well as significantly higher at 12 months relative to 36 months (p<0.001) (Figure 1A). The T1rho relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001), and 36 months (p<0.001) (Figure 1B). The two-year T2 relaxation times and T1rho relaxation times were significantly correlated with the KOOS Sports, Pain, Symptoms, and Activities of Daily Living sub-scores.
Conclusion:
We observed significant changes in the tendon graft over time following ACL reconstruction with hamstring autograft, reflecting a higher concentration of proteoglycan and more longitudinally-organized collagen structure over time. Improved collagen organization (lower T2 values) and increased proteoglycan content (lower T1rho values) were correlated with better outcomes based on KOOS scores. Quantitative T2 and T1rho relaxation times of ACL graft may offer a non-invasive method for monitoring graft maturation that correlates with patient-reported knee function after ACL reconstruction.
Figure 1.
The mean T2 relaxation time (A) and mean T1ρ relaxation time (B) is shown for patients following ACL reconstruction with hamstring autograft at four post-operative time points following ACL reconstruction. * indicates p<0.001 relative to 12, 24, and 36 months. # indicates p<0.001 relative to 36 months.
Table 1:
Correlations between two-year post-operative KOOS scores and two-year T2 and T1ρ relaxation times of ACL graft following autograft hamstring ACL reconstruction
Two-Year Post-Operative KOOS Sub-Scores
Imaging Sequence
Sports
Pain
Symptoms
ADLs
Quality of Life
T2
Spearman’s Correlation
-0.73
-0.62
-0.63
-0.41
-0.31
P Value
<0.001
<0.001
<0.001
0.04
0.13
T1ρ
Spearman’s Correlation
-0.72
-0.64
-0.61
-0.43
-0.26
P Value
<0.001
<0.001
<0.001
0.03
0.21 |
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AbstractList | Objectives:
Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization. Collagen within the ACL graft becomes organized along the long-axis of the ligament and the proteoglycan content increases. Quantitative imaging sequences, specifically T2 and T1rho, allow for a non-invasive assessment of collagen orientation and proteoglycan content, respectively. The purpose of this study was to investigate the longitudinal progression of T2 and T1rho relaxation times of the graft after ACL reconstruction and the relationship between these quantitative imaging markers and patient-reported outcome measures. We hypothesized that T2 and T1rho would decrease significantly over time, reflecting improved collagen organization and ncreased proteoglycan content, and that T2 and T1rho relaxation times would be inversely correlated with Knee Osteoarthritis Outcome Scores (KOOS).
Methods:
Thirty-two patients (mean age 29.4±8.2 years, 12 females) were followed prospectively after arthroscopic ACL reconstruction with hamstring autograft. Patients provided informed consent and all procedures were IRB-approved. Exclusion criteria included allograft reconstruction, other ligamentous injury, meniscal tear requiring repair, prior knee surgery, or history of arthritis. Post-operative MR imaging was obtained for 31 patients at 6 months, 30 patients at 12 months, 26 patients at 24 months, and 23 patients at 36 months after surgery. T2 and T1rho relaxation times were simultaneously acquired with a combined 3D sagittal sequence using a 3 T MR system (GE Healthcare) with a 1Tx/8Rx knee coil. The intra-articular ACL graft was identified on a fat-suppressed sagittal high-resolution 3D fast spin echo images and manually segmented. The T2 and T1rho relaxation times for the graft were recorded. Patients completed the KOOS at each imaging time point. Repeated measures analysis of variance (ANOVA) tests with Tukey corrections were used to compare T2 and T1rho relaxation times between time points. The relationship between KOOS and T2 and T1rho values at 2 years post-operative was investigated with Spearman’s rank correlation. Significance was defined as p<0.05.
Results:
The T2 relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001,) and 36 months (p<0.001) after ACL reconstruction, as well as significantly higher at 12 months relative to 36 months (p<0.001) (Figure 1A). The T1rho relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001), and 36 months (p<0.001) (Figure 1B). The two-year T2 relaxation times and T1rho relaxation times were significantly correlated with the KOOS Sports, Pain, Symptoms, and Activities of Daily Living sub-scores.
Conclusion:
We observed significant changes in the tendon graft over time following ACL reconstruction with hamstring autograft, reflecting a higher concentration of proteoglycan and more longitudinally-organized collagen structure over time. Improved collagen organization (lower T2 values) and increased proteoglycan content (lower T1rho values) were correlated with better outcomes based on KOOS scores. Quantitative T2 and T1rho relaxation times of ACL graft may offer a non-invasive method for monitoring graft maturation that correlates with patient-reported knee function after ACL reconstruction.
Figure 1.
The mean T2 relaxation time (A) and mean T1ρ relaxation time (B) is shown for patients following ACL reconstruction with hamstring autograft at four post-operative time points following ACL reconstruction. * indicates p<0.001 relative to 12, 24, and 36 months. # indicates p<0.001 relative to 36 months.
Table 1:
Correlations between two-year post-operative KOOS scores and two-year T2 and T1ρ relaxation times of ACL graft following autograft hamstring ACL reconstruction
Two-Year Post-Operative KOOS Sub-Scores
Imaging Sequence
Sports
Pain
Symptoms
ADLs
Quality of Life
T2
Spearman’s Correlation
-0.73
-0.62
-0.63
-0.41
-0.31
P Value
<0.001
<0.001
<0.001
0.04
0.13
T1ρ
Spearman’s Correlation
-0.72
-0.64
-0.61
-0.43
-0.26
P Value
<0.001
<0.001
<0.001
0.03
0.21 Objectives: Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization. Collagen within the ACL graft becomes organized along the long-axis of the ligament and the proteoglycan content increases. Quantitative imaging sequences, specifically T2 and T1rho, allow for a non-invasive assessment of collagen orientation and proteoglycan content, respectively. The purpose of this study was to investigate the longitudinal progression of T2 and T1rho relaxation times of the graft after ACL reconstruction and the relationship between these quantitative imaging markers and patient-reported outcome measures. We hypothesized that T2 and T1rho would decrease significantly over time, reflecting improved collagen organization and ncreased proteoglycan content, and that T2 and T1rho relaxation times would be inversely correlated with Knee Osteoarthritis Outcome Scores (KOOS). Methods: Thirty-two patients (mean age 29.4±8.2 years, 12 females) were followed prospectively after arthroscopic ACL reconstruction with hamstring autograft. Patients provided informed consent and all procedures were IRB-approved. Exclusion criteria included allograft reconstruction, other ligamentous injury, meniscal tear requiring repair, prior knee surgery, or history of arthritis. Post-operative MR imaging was obtained for 31 patients at 6 months, 30 patients at 12 months, 26 patients at 24 months, and 23 patients at 36 months after surgery. T2 and T1rho relaxation times were simultaneously acquired with a combined 3D sagittal sequence using a 3 T MR system (GE Healthcare) with a 1Tx/8Rx knee coil. The intra-articular ACL graft was identified on a fat-suppressed sagittal high-resolution 3D fast spin echo images and manually segmented. The T2 and T1rho relaxation times for the graft were recorded. Patients completed the KOOS at each imaging time point. Repeated measures analysis of variance (ANOVA) tests with Tukey corrections were used to compare T2 and T1rho relaxation times between time points. The relationship between KOOS and T2 and T1rho values at 2 years post-operative was investigated with Spearman’s rank correlation. Significance was defined as p<0.05. Results: The T2 relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001,) and 36 months (p<0.001) after ACL reconstruction, as well as significantly higher at 12 months relative to 36 months (p<0.001) (Figure 1A). The T1rho relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001), and 36 months (p<0.001) (Figure 1B). The two-year T2 relaxation times and T1rho relaxation times were significantly correlated with the KOOS Sports, Pain, Symptoms, and Activities of Daily Living sub-scores. Conclusion: We observed significant changes in the tendon graft over time following ACL reconstruction with hamstring autograft, reflecting a higher concentration of proteoglycan and more longitudinally-organized collagen structure over time. Improved collagen organization (lower T2 values) and increased proteoglycan content (lower T1rho values) were correlated with better outcomes based on KOOS scores. Quantitative T2 and T1rho relaxation times of ACL graft may offer a non-invasive method for monitoring graft maturation that correlates with patient-reported knee function after ACL reconstruction. [Figure: see text][Table: see text] Objectives:Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization. Collagen within the ACL graft becomes organized along the long-axis of the ligament and the proteoglycan content increases. Quantitative imaging sequences, specifically T2 and T1rho, allow for a non-invasive assessment of collagen orientation and proteoglycan content, respectively. The purpose of this study was to investigate the longitudinal progression of T2 and T1rho relaxation times of the graft after ACL reconstruction and the relationship between these quantitative imaging markers and patient-reported outcome measures. We hypothesized that T2 and T1rho would decrease significantly over time, reflecting improved collagen organization and ncreased proteoglycan content, and that T2 and T1rho relaxation times would be inversely correlated with Knee Osteoarthritis Outcome Scores (KOOS).Methods:Thirty-two patients (mean age 29.4±8.2 years, 12 females) were followed prospectively after arthroscopic ACL reconstruction with hamstring autograft. Patients provided informed consent and all procedures were IRB-approved. Exclusion criteria included allograft reconstruction, other ligamentous injury, meniscal tear requiring repair, prior knee surgery, or history of arthritis. Post-operative MR imaging was obtained for 31 patients at 6 months, 30 patients at 12 months, 26 patients at 24 months, and 23 patients at 36 months after surgery. T2 and T1rho relaxation times were simultaneously acquired with a combined 3D sagittal sequence using a 3 T MR system (GE Healthcare) with a 1Tx/8Rx knee coil. The intra-articular ACL graft was identified on a fat-suppressed sagittal high-resolution 3D fast spin echo images and manually segmented. The T2 and T1rho relaxation times for the graft were recorded. Patients completed the KOOS at each imaging time point. Repeated measures analysis of variance (ANOVA) tests with Tukey corrections were used to compare T2 and T1rho relaxation times between time points. The relationship between KOOS and T2 and T1rho values at 2 years post-operative was investigated with Spearman’s rank correlation. Significance was defined as p<0.05.Results:The T2 relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001,) and 36 months (p<0.001) after ACL reconstruction, as well as significantly higher at 12 months relative to 36 months (p<0.001) (Figure 1A). The T1rho relaxation times of the ACL graft were significantly higher at 6 months relative to 12 months (p<0.001), 24 months (p<0.001), and 36 months (p<0.001) (Figure 1B). The two-year T2 relaxation times and T1rho relaxation times were significantly correlated with the KOOS Sports, Pain, Symptoms, and Activities of Daily Living sub-scores.Conclusion:We observed significant changes in the tendon graft over time following ACL reconstruction with hamstring autograft, reflecting a higher concentration of proteoglycan and more longitudinally-organized collagen structure over time. Improved collagen organization (lower T2 values) and increased proteoglycan content (lower T1rho values) were correlated with better outcomes based on KOOS scores. Quantitative T2 and T1rho relaxation times of ACL graft may offer a non-invasive method for monitoring graft maturation that correlates with patient-reported knee function after ACL reconstruction.Table 1:Correlations between two-year post-operative KOOS scores and two-year T2 and T1ρ relaxation times of ACL graft following autograft hamstring ACL reconstructionTwo-Year Post-Operative KOOS Sub-ScoresImaging SequenceSportsPainSymptomsADLsQuality of LifeT2Spearman’s Correlation-0.73-0.62-0.63-0.41-0.31P Value<0.001<0.001<0.0010.040.13T1ρSpearman’s Correlation-0.72-0.64-0.61-0.43-0.26P Value<0.001<0.001<0.0010.030.21 |
Author | Lansdown, Drew A. Allen, Christina R. Feeley, Brian T. Majumdar, Sharmila Xiao, Weiyuan Li, Xiaojuan Ma, Chunbong Benjamin Zhang, Alan L. |
AuthorAffiliation | 6 Cleveland Clinic, Cleveland, OH, USA 4 UCSF Ortho Institute, San Francisco, CA, USA 7 UCSF, San Francisco, CA, USA 1 University of California San Francisco Program, San Francisco, CA, USA 2 Shanghai Jiao Tong University, Shanghai, China 3 UCSF Medical Center, San Francisco, CA, USA 5 University of California, San Francisco, San Francisco, CA, USA |
AuthorAffiliation_xml | – name: 1 University of California San Francisco Program, San Francisco, CA, USA – name: 6 Cleveland Clinic, Cleveland, OH, USA – name: 4 UCSF Ortho Institute, San Francisco, CA, USA – name: 2 Shanghai Jiao Tong University, Shanghai, China – name: 3 UCSF Medical Center, San Francisco, CA, USA – name: 7 UCSF, San Francisco, CA, USA – name: 5 University of California, San Francisco, San Francisco, CA, USA |
Author_xml | – sequence: 1 givenname: Drew A. surname: Lansdown fullname: Lansdown, Drew A. – sequence: 2 givenname: Weiyuan surname: Xiao fullname: Xiao, Weiyuan – sequence: 3 givenname: Alan L. surname: Zhang fullname: Zhang, Alan L. – sequence: 4 givenname: Christina R. surname: Allen fullname: Allen, Christina R. – sequence: 5 givenname: Brian T. surname: Feeley fullname: Feeley, Brian T. – sequence: 6 givenname: Xiaojuan surname: Li fullname: Li, Xiaojuan – sequence: 7 givenname: Sharmila surname: Majumdar fullname: Majumdar, Sharmila – sequence: 8 givenname: Chunbong Benjamin surname: Ma fullname: Ma, Chunbong Benjamin |
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Snippet | Objectives:
Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization.... Objectives:Following surgical reconstruction of the anterior cruciate ligament (ACL), the tendon graft undergoes a remodeling process of ligamentization.... |
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StartPage | 2325967119 |
SubjectTerms | Arthritis Collagen Knee Orthopedics Patients Sports medicine Variance analysis |
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Title | ACL Graft Signal Characteristics Measured by Quantitative MRI Are Significantly Correlated with Patient Reported Outcomes Two-Years after Hamstring Autograft ACL Reconstruction |
URI | https://journals.sagepub.com/doi/full/10.1177/2325967119S00352 https://www.proquest.com/docview/2375745791/abstract/ https://pubmed.ncbi.nlm.nih.gov/PMC6664639 |
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