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

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 31; no. 5; pp. 1690 - 1698
• Main Authors: Flannery, Sean W., Murray, Martha M., Badger, Gary J., Ecklund, Kirsten, Kramer, Dennis E., Fleming, Braden C., Kiapour, Ata M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2023; Springer Nature B.V
• Subjects: Age factors; Anterior cruciate ligament; Anterior Cruciate Ligament Injuries - surgery; Anterior Cruciate Ligament Reconstruction - methods; Bivariate analysis; Body mass; Body mass index; Body size; Clinical outcomes; Demographic variables; Demographics; Demography; Failure load; Humans; Image acquisition; Image reconstruction; Knee; Magnetic Resonance Imaging; Mathematical analysis; Medicine; Medicine & Public Health; Orthopedics; Patients; Prospective Studies; Regression analysis; Rehabilitation; Retrospective Studies; Sports Medicine; Surgery; Surgical outcomes; Ligament healing; MRI; ACL restoration; qMRI; ACL; Rehabilitation; Outcomes
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-022-07000-8

Purpose
Quantitative magnetic resonance imaging (qMRI) has been used to determine the failure properties of ACL grafts and native ACL repairs and/or restorations. How these properties relate to future clinical, functional, and patient-reported outcomes remain unknown. The study objective was to investigate the relationship between non-contemporaneous qMRI measures and traditional outcome measures following Bridge-Enhanced ACL Restoration (BEAR). It was hypothesized that qMRI parameters at 6 months would be associated with clinical, functional, and/or patient-reported outcomes at 6 months, 24 months, and changes from 6 to 24 months post-surgery.
Methods
Data of BEAR patients (
n
 = 65) from a randomized control trial of BEAR versus ACL reconstruction (BEAR II Trial; NCT02664545) were utilized retrospectively for the present analysis. Images were acquired using the Constructive Interference in Steady State (CISS) sequence at 6 months post-surgery. Single-leg hop test ratios, arthrometric knee laxity values, and International Knee Documentation Committee (IKDC) subjective scores were determined at 6 and 24 months post-surgery. The associations between traditional outcomes and MRI measures of normalized signal intensity, mean cross-sectional area (CSA), volume, and estimated failure load of the healing ACL were evaluated based on bivariate correlations and multivariable regression analyses, which considered the potential effects of age, sex, and body mass index.
Results
CSA (
r
 = 0.44,
p
 = 0.01), volume (
r
 = 0.44,
p
 = 0.01), and estimated failure load (
r
 = 0.48,
p
 = 0.01) at 6 months were predictive of the change in single-leg hop ratio from 6 to 24 months in bivariate analysis. CSA (β
standardized
 = 0.42,
p
 = 0.01), volume (β
standardized
 = 0.42,
p
 = 0.01), and estimated failure load (β
standardized
 = 0.48,
p
 = 0.01) remained significant predictors when considering the demographic variables. No significant associations were observed between MRI variables and either knee laxity or IKDC when adjusting for demographic variables. Signal intensity was also not significant at any timepoint.
Conclusion
The qMRI-based measures of CSA, volume, and estimated failure load were predictive of a positive functional outcome trajectory from 6 to 24 months post-surgery. These variables measured using qMRI at 6 months post-surgery could serve as prospective markers of the functional outcome trajectory from 6 to 24 months post-surgery, aiding in rehabilitation programming and return-to-sport decisions to improve surgical outcomes and reduce the risk of reinjury.
Level of evidence
Level II.