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Greater magnitude tibiofemoral contact forces are associated with reduced prevalence of osteochondral pathologies 2–3 years following anterior cruciate ligament reconstruction

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

External loading of osteoarthritic and healthy knees correlates with current and future osteochondral tissue state. These relationships have not been examined following anterior cruciate ligament reconstruction. We hypothesised greater magnitude tibiofemoral contact forces were related to increased prevalence of osteochondral pathologies, and these relationships were exacerbated by concomitant meniscal injury.

Methods

This was a cross-sectional study of 100 individuals (29.7 ± 6.5 years, 78.1 ± 14.4 kg) examined 2–3 years following hamstring tendon anterior cruciate ligament reconstruction. Thirty-eight participants had concurrent meniscal pathology (30.6 ± 6.6 years, 83.3 ± 14.3 kg), which included treated and untreated meniscal injury, and 62 participants (29.8 ± 6.4 years, 74.9 ± 13.3 kg) were free of meniscal pathology. Magnetic resonance imaging of reconstructed knees was used to assess prevalence of tibiofemoral osteochondral pathologies (i.e., cartilage defects and bone marrow lesions). A calibrated electromyogram-driven neuromusculoskeletal model was used to predict medial and lateral tibiofemoral compartment contact forces from gait analysis data. Relationships between contact forces and osteochondral pathology prevalence were assessed using logistic regression models.

Results

In patients with reconstructed knees free from meniscal pathology, greater medial contact forces were related to reduced prevalence of medial cartilage defects (odds ratio (OR) = 0.7, Wald χ2(2) = 7.9, 95% confidence interval (CI) = 0.50–95, p = 0.02) and medial bone marrow lesions (OR = 0.8, Wald χ2(2) = 4.2, 95% CI = 0.7–0.99, p = 0.04). No significant relationships were found in lateral compartments. In reconstructed knees with concurrent meniscal pathology, no relationships were found between contact forces and osteochondral pathologies.

Conclusions

In patients with reconstructed knees free from meniscal pathology, increased contact forces were associated with fewer cartilage defects and bone marrow lesions in medial, but not, lateral tibiofemoral compartments. No significant relationships were found between contact forces and osteochondral pathologies in reconstructed knees with meniscal pathology for any tibiofemoral compartment. Future studies should focus on determining longitudinal effects of contact forces and changes in osteochondral pathologies.

Level of evidence

IV.

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Acknowledgements

The authors would like to acknowledge Dr. Alasdair Dempsey and Dr. Nicole Grigg for their contributions to data collection, and Dr. Cameron Norsworthy for assisting with recruitment of participants.

Funding

We acknowledge funding support from the Australian National Health and Medical Research Council (NHMRC) Project Grant (to ALB, DGL, KLB and FMC, Grant #628850), NHMRC R. D. Wright Biomedical Fellowship (to ALB), NHMRC Career Development Fellowship (to YW), and Principal Research Fellowship (to KLB). Dr. David John Saxby would like to acknowledge Griffith University for Ph.D. scholarship and stipend awards, as well as the International Society of Biomechanics for Matching Dissertation Grant.

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Authors and Affiliations

  1. Core Group for Innovation in Health Technology, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia

    David John Saxby, Jason M. Konrath, Christopher Vertullo & David G. Lloyd

  2. School of Allied Health Sciences, Griffith University, Gold Coast, Australia

    David John Saxby, Jason M. Konrath & David G. Lloyd

  3. Gold Coast Orthopaedic Research and Education Alliance, Griffith University, Gold Coast, Australia

    David John Saxby, Jason M. Konrath, Christopher Vertullo & David G. Lloyd

  4. Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia

    Adam L. Bryant, Ans Van Ginckel, Xinyang Wang, Karine Fortin, Tim V. Wrigley & Kim L. Bennell

  5. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Yuanyuan Wang & Flavia M. Cicuttini

  6. Department of Civil and Environmental Engineering, Imperial College London, London, UK

    Luca Modenese

  7. Laboratory of Human Motion, Education and Health, University of Nice Sophia-Antipolis, Nice, France

    Pauline Gerus

  8. Knee Research Australia, Gold Coast, Australia

    Christopher Vertullo

  9. OrthoSport Victoria, Epworth Richmond, Melbourne, Australia

    Julian A. Feller

  10. College of Science, Health and Engineering, La Trobe University, Melbourne, Australia

    Julian A. Feller & Tim Whitehead

  11. Coast Orthopaedics, Gold Coast, Australia

    Price Gallie

  12. Room 2.05, G02, Clinical Sciences 1, Griffith University, Gold Coast Campus, Gold Coast, 4222, Australia

    David John Saxby

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  1. David John Saxby
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Correspondence to David John Saxby.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Saxby, D.J., Bryant, A.L., Van Ginckel, A. et al. Greater magnitude tibiofemoral contact forces are associated with reduced prevalence of osteochondral pathologies 2–3 years following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 27, 707–715 (2019). https://doi.org/10.1007/s00167-018-5006-3

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