| Objective:To evaluate the difference of the cartilage injury between the anterior cruciate ligament reconstruction?ACLR?and conservative interventions for anterior cruciate ligament tears in a short term using MRI follow-up.Methods:Seventy three participants with ACL tear were recruited from May to October,2017 in our hospital.Mean age of 25 participants with conservative treatment for ACL tear was 43.4±12.7 years.And mean age of 48 participants underwent ACLR was 30.2±9.9 years.In ACLR group,29,16 and 3 patients underwent allogenic,allogenic,and allogenic combined with allogenic single-bundle ACLR,respectively.All patients were examined within 1-12 weeks of injury prior to surgical reconstruction or conservative?baseline?,3-and 6-months after treatment respectively by using 3.0 Tesla magnetic resonance scanner.Knees were imaged using conventional MRI scanning sequences[T1-weighted and proton density?PD?-weighted fat-saturated spin-echo acquisition in the sagittal plane,T2-multi-echo data image combination?MEDIC?in the coronal plane,and short TI inversion recovery?STIR?sequence in the axial plane]for a semi-quantitative image analysis--Anterior Cruciate Ligament OsteoArthritis Score?ACLOAS?;3D-dual-echo steady-state?3D-DESS?sequence in the sagittal plane for cartilage volume assessment and T2 mapping in the sagittal plane for cartilage morphology assessment.The cartilage of all knees were recongnized and segmented into 8compartments auotomatically:patella?P?,femoral trochlea?TrF?,medial femoral condyle?MFC?,lateral femoral condyle?LFC?,posterior medial femoral condyle?pMFC?,posterior lateral femoral condyle?pLFC?,medial tibial plateau?MT?,lateral tibial plateau?LT?in 3D-DESS images by using Siemens KneeCap?Version 1.5?software.And each subregion's cartilage volume was measured?unit:ml?.T2 relaxation time values of the eight subregion's were calculated from the multi-echo images of each cartilage plate.All patients completed the Knee-Injury and Osteoarthritis Outcome Score?KOOS?at baseline and each follow-up.A Student's t test was used to compare articular cartilage T2 values,change rate of cartilage volume[CV%=?follow up CV-baseline CV?/baseline CV×100%]and KOOS score at baseline,3-month follow-up,and 6-month follow-up if the data obey the normal distribution and variance,otherwise the signed rank test was used.A paired Student's t test was used to compare the T2 and KOOS cartilage between the conservative and surgical group,at baseline and 3-month follow-up,6-month follow-up respectively if the data obey the normal distribution and variance,otherwise the signed rank test was used.Chi-square test was used to compare proportions in ACLOAS.All statistical analyses were performed on SPSS package?version 21.0?with significance accepted at P<0.05.Results:A total number of 73 participants were enrolled.Two independent groups were examined:?i?conservative group--non-surgical therapy?n=25?,8cases were followed at 3-month,12 cases were followed at 6-month,and 5cases were followed at the two follow up visits;?ii?ACLR group?n=48?,34cases were followed at 3-month,33 cases were followed at 6-month,and 25cases were followed at the two follow up visits.Using the Siemens KneeCap?Version 1.5?software,some images were unable to identified or identified error.The number of segmentation successfully in conservative and ACLR group were 21 and 42 cases at baseline,7 and 25 cases at 3-month follow-up,11 and 26 cases at 6-month follow-up,respectively.1.Comparison of cartilage between the conservative group and the ACLR group1.1 Comparison of T2 values of articular cartilage in each subregion of the knee jointAt baseline,3-month follow-up and 6-month follow-up,there were no significant differences in the T2 values of the articular cartilage between the conservative and ACLR group.From baseline to 3-month follow-up,T2 values in each subregion of conservative group were not statistically significant,while T2 values significantly increased in p LFC and LFC cartilage of ACLR group?P=0.002,P=0.037?.From baseline to 6-month follow-up,T2 values significantly increased in P,MFC,pLFC and TrF of conservative group?P=0.005,P=0.015,P=0.047,P=0.011?;and in P,MFC,LF,LFC cartilage of ACLR group?P<0.001,P<0.001,P=0.003 P<0.001?.1.2 Comparison of CV%in each subregion of the knee jointFrom baseline to 3-month follow-up,CV%significantly changed in LF and MT between the two groups?P=0.035,P=0.006?.From baseline to 6-month follow-up,CV%in each subregion between the two groups were not statistically significant.2.Comparison of ACLOAS between the two groupsThe scoring indexes included articular cartilage,BMELs,osteophyte,collateral ligament and posterior cruciate ligament?PCL?,effusion-synovitis,Hoffa-synovitis.There were no significant differences between the two groups from baseline to 3 and 6 months'follow-up.3.Comparison of KOOS scores between the two groupsThe KOOS subscale scores of sport were significantly higher in conservative group than ACLR group?P=0.031?.At 3-month follow-up,the scores of sport and symptom in conservative group were significant higher than ACLR group?P=0.001,P=0.002?.At 6-month follow-up,the two groups showed no significant KOOS subscale differences.At 3-month follow-up,pain scores were significantly higher than those participants at baseline,?P=0.046?;while there were no significant KOOS subscale differences in ACLR group.At 6-month follow-up,there were no significant KOOS subscale differences in conservative group,but daily life,pain,physical exercise,symptom scores were significant higher than those participants at baseline?P=0.001,P<0.001,P<0.001,P<0.001?.Conclusion:1.From baseline to 6-month follow-up,there were no significant differences in articular cartilage defects between the two groups,including T2 values and cartilage morphology score by ACLOAS.At 3-month follow up,the CV%of pLFC in conservative group?n=7?and ACLR group?n=25?were 4.5%and-6.4%respectively;while the CV%of MT were-4.4%and 2.8%.At 6-month follow-up,CV%of each subregion cartilage between the two groups were no significant differences.That is to say,from baseline to 6-month follow up,there were no significant differences in articular cartilage defects between the two groups.2.However,longitudinal increase of T2 values in deferent subregions in the two groups,suggesting cartilage degeneration were not exactly the same.In ACLR group,articular cartilage injury appeared on LFC,p LFC at 3-month follow-up,while in conservative group there were no cartilage injury.Up to 6months,articular cartilage injury appeared on P,MFC and LFC,pLFC in ACLR group,while on P and TrF,MFC and pLFC cartilage injury in conservative group.articular cartilage injury in the ACLR group was earlier than in conservative.And the same articular cartilage injury appeared on P,MFC and pLFC in the two groups,while also LFC in ACLR group,TrF in conservative group.3.During the following period,the subjective feeling of the conservative group and the ACLR group gradually improved,after 3 months of follow-up,the mean score of ACLR group activities of daily living was still lower than the conservative group,as well as symptoms.After 6-month follow-up,the two groups showed no significant KOOS subscale differences.In ACLR group,the score of symptoms,pain,activities of daily living and sport and recreation function were higher than preoperative.The subjective feeling of the conservative group gradually improved before 3 months,while the ACLR group improved after 6 months.From baseline to 6-month follow-up,there were no significant differences in articular cartilage defects in the two groups,including cartilage volume change and cartilage morphology score by ACLOAS,while T2 values were changed,indicating that the cartilage T2 value was more sensitive than the change of cartilage volume in monitoring cartilage injury. |
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