Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

Open Access 26-10-2023 | Arthroscopy | KNEE

Postoperative quadriceps weakness and male sex are risk factors for patellofemoral articular cartilage lesions after anatomical anterior cruciate ligament reconstruction

Authors: Ryo Murakami, Shuji Taketomi, Ryota Yamagami, Kenichi Kono, Kohei Kawaguchi, Tomofumi Kage, Takahiro Arakawa, Hiroshi Inui, Sakae Tanaka

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2023

Abstract

Purpose

Patellofemoral (PF) compartment cartilage lesions are a frequent problem after anterior cruciate ligament (ACL) reconstruction. This study aimed to determine the factors that influence PF cartilage lesions after anatomical ACL reconstruction.

Methods

This study enrolled a total of 114 patients who did not manifest PF compartment cartilage lesions during anatomical ACL reconstruction and underwent second-look arthroscopy 18 months postoperatively. Arthroscopy using the International Cartilage Repair Society (ICRS) classification was used to assess cartilage lesions. The correlation between surgical findings, radiographic factors, and clinical factors and change of ICRS grade was analysed. Multivariate regression analysis was conducted to reveal the independent risk factors for PF cartilage lesions among patients’ demographic data and parameters that correlated with the change of ICRS grade in the correlation analyses.

Results

ICRS grade changes in PF cartilage were significantly correlated with age, sex, quadriceps strength at 1 year postoperatively, hamstrings strength at pre- and 1 year postoperatively, and single leg hop test at 1 year postoperatively. However, no significant correlation was found between the time between injury and surgery, posterior tibial slope angle, pre- and postoperative Tegner activity scale, graft type, initial graft tension, meniscus injury, meniscus injury treatment, pre- and postoperative range of motion, anteroposterior laxity and preoperative quadriceps strength, and the change in ICRS grade. Multivariate regression analysis revealed male (P = 0.019) and quadriceps strength weakness at 1 year postoperatively (P = 0.009) as independent risk factors for PF cartilage lesions.

Conclusions

Quadriceps strength weakness 1 year after ACL reconstruction and males were correlated with a new PF cartilage lesion after anatomical ACL reconstruction, with no significant correlation between bone-patellar tendon-bone autograft, initial graft tension, or extension deficit and new PF cartilage lesion. Rehabilitation that focuses on quadriceps strength after ACL reconstruction is recommended to prevent new PF cartilage lesions.

Level of evidence

Level IV.

Barenius B, Ponzer S, Shalabi A, Bujak R, Norlén L, Eriksson K (2014) Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 42(5):1049–1057CrossRefPubMed

Byrne KJ, Hughes JD, Gibbs C, Vaswani R, Meredith SJ, Popchak A, Lesniak BP, Karlsson J, Irrgang JJ, Musahl V (2022) Non-anatomic tunnel position increases the risk of revision anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 30(4):1388–1395CrossRefPubMed

Costa MQ, Badger GJ, Chrostek CA, Carvalho OD, Faiola SL, Fadale PD, Hulstyn MJ, Gil HC, Shalvoy RM, Fleming BC (2022) Effects of initial graft tension and patient sex on knee osteoarthritis outcomes after ACL reconstruction: a randomized controlled clinical trial with 10- to 12-year follow-up. Am J Sports Med 50(13):3510–3521CrossRefPubMedPubMedCentral

Culvenor AG, Lai CC, Gabbe BJ, Makdissi M, Collins NJ, Vicenzino B, Morris HG, Crossley KM (2014) Patellofemoral osteoarthritis is prevalent and associated with worse symptoms and function after hamstring tendon autograft ACL reconstruction. Br J Sports Med 48(6):435–439CrossRefPubMed

Ersoz M, Ergun S (2003) Relationship between knee range of motion and Kellgren-Lawrence radiographic scores in knee osteoarthritis. Am J Phys Med Rehabil 82(2):110–115CrossRefPubMed

Fleming BC, Fadale PD, Hulstyn MJ, Shalvoy RM, Tung GA, Badger GJ (2021) Long-term outcomes of anterior cruciate ligament reconstruction surgery: 2020 OREF clinical research award paper. J Orthop Res 39(5):1041–1051CrossRefPubMed

Grassi A, Pizza N, Al-Zu’bi BBH, Fabbro GD, Lucidi GA, Zaffagnini S (2022) Clinical outcomes and osteoarthritis at very long-term follow-up after ACL reconstruction: a systematic review and meta-analysis. Orthop J Sports Med 10(1):23259671211062240CrossRefPubMedPubMedCentral

Huang H, Li Z, Luo S, Zheng J, Zhou G, Wang G (2022) Factors influencing the progression of patellofemoral articular cartilage damage after anterior cruciate ligament reconstruction. Orthop J Sports Med 10(7):23259671221108360CrossRefPubMedPubMedCentral

Huang W, Ong TY, Fu SC, Yung SH (2020) Prevalence of patellofemoral joint osteoarthritis after anterior cruciate ligament injury and associated risk factors: A systematic review. J Orthop Translat 22:14–25CrossRefPubMed

10.

Huang W, Ong MT, Man GC, Liu Y, Lau LC, Yung PS (2021) Posterior tibial loading results in significant increase of peak contact pressure in the patellofemoral joint during anterior cruciate ligament reconstruction: a cadaveric study. Am J Sports Med 49(5):1286–1295CrossRefPubMed

11.

Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38(3):455–463CrossRefPubMed

12.

Lee DW, Yeom CH, Kim DH, Kim TM, Kim JG (2018) Prevalence and predictors of patellofemoral osteoarthritis after anterior cruciate ligament reconstruction with hamstring tendon autograft. Clin Orthop Surg 10(2):181–190CrossRefPubMedPubMedCentral

13.

Lindanger L, Strand T, Mølster AO, Solheim E, Fischer-Bredenbeck C, Ousdal OT, Inderhaug E (2022) Predictors of osteoarthritis development at a median 25 years after anterior cruciate ligament reconstruction using a patellar tendon autograft. Am J Sports Med 50(5):1195–1204CrossRefPubMed

14.

Macchiarola L, Jacquet C, Dor J, Zaffagnini S, Mouton C, Seil R (2022) Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc 30(5):1691–1699CrossRefPubMed

15.

Mae T, Shino K, Nakata K, Toritsuka Y, Otsubo H, Fujie H (2008) Optimization of graft fixation at the time of anterior cruciate ligament reconstruction, part I: effect of initial tension. Am J Sports Med 36(6):1087–1093CrossRefPubMed

16.

Mainil-Varlet P, Aigner T, Brittberg M, Bullough P, Hollander A, Hunziker E, et al. (2003) Histological assessment of cartilage repair: A report by the Histology Endpoint Committee of the International Cartilage Repair Society (ICRS). J Bone Joint Surg Am 85(A Suppl 2):45–57.

17.

MARS Group; Magnussen RA, Borchers JR, Pedroza AD, Huston LJ, Haas AK, et al. (2018) Risk factors and predictors of significant chondral surface change from primary to revision anterior cruciate ligament reconstruction: a MOON and MARS cohort study. Am J Sports Med 46(3):557–564.

18.

Nakazato K, Taketomi S, Inui H, Yamagami R, Kawaguchi K, Tanaka S (2021) Lateral posterior tibial slope and length of the tendon within the tibial tunnel are independent factors to predict tibial tunnel widening following anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 29(11):3818–3824CrossRefPubMed

19.

Noyes FR, Barber SD, Mangine RE (1991) Abnormal lower limb symmetry determined by function hop tests after anterior cruciate ligament rupture. Am J Sports Med 19(5):513–518CrossRefPubMed

20.

Oak SR, Cantrell WA, Altahawi F, Li X, Winalski CS, Flanigan DC, Reinke EK, Huston LJ, Jones MH, Spindler KP (2021) Do bone-patellar tendon-bone ACL-reconstructed knees have more signs of patellofemoral posttraumatic osteoarthritis than their uninjured contralateral knees at 2 years? Orthop J Sports Med 9(1):2325967120973050CrossRefPubMedPubMedCentral

21.

Pius AK, Beynnon BD, Fiorentino N, Gardner-Morse M, Vacek PM, DeSarno M, Failla M, Slauterbeck JR, Sturnick DR, Argentieri EC, Tourville TW (2022) Articular cartilage thickness changes differ between males and females 4 years following anterior cruciate ligament reconstruction. J Orthop Res 40(1):65–73CrossRefPubMed

22.

Powers CM, Landel R, Perry J (1996) Timing and intensity of vastus muscle activity during functional activities in subjects with and without patellofemoral pain. Phys Ther 76(9):946–955; discussion 956.

23.

Rodriguez KM, Curran MT, Palmieri-Smith RM (2022) The influence of sex, body mass index, and age on cartilage metabolism biomarkers in patients after anterior cruciate ligament injury and reconstruction. J Athl Train 57(5):478–484CrossRefPubMed

24.

Scholes C, Ektas N, Harrison-Brown M, Jegatheesan M, Rajesh A, Kirwan G, Bell C (2023) Persistent knee extension deficits are common after anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomised controlled trials. Knee Surg Sports Traumatol Arthrosc 31(8):3172–3185CrossRefPubMed

25.

Shatrov J, Freychet B, Hopper GP, Coulin B, El Helou A, An JS, Vieira TD, Sonnery-Cottet B (2023) Radiographic incidence of knee osteoarthritis after isolated ACL reconstruction versus combined acl and all reconstruction: a prospective matched study from the SANTI Study Group. Am J Sports Med 51(7):1686–1697CrossRefPubMed

26.

Shino K, Nakata K, Nakamura N, Toritsuka Y, Horibe S, Nakagawa S, Suzuki T (2008) Rectangular tunnel double-bundle anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft to mimic natural fiber arrangement. Arthroscopy 24(10):1178–1183CrossRefPubMed

27.

Tahara K, Yamagami R, Taketomi S, Inui H, Tanaka S (2022) High initial graft tension increases external tibial rotation on the axial plane after anatomical anterior cruciate ligament reconstruction. Arch Orthop Trauma Surg 142(7):1597–1604CrossRefPubMed

28.

Taketomi S, Inui H, Yamagami R, Shirakawa N, Kawaguchi K, Nakagawa T, Tanaka S (2018) Bone-patellar tendon-bone autograft versus hamstring tendon autograft for anatomical anterior cruciate ligament reconstruction with three-dimensional validation of femoral and tibial tunnel positions. J Knee Surg 31(9):866–874CrossRefPubMed

29.

Tashman S, Zandiyeh P, Irrgang JJ, Musahl V, West RV, Shah N, Fu FH (2021) Anatomic single- and double-bundle ACL reconstruction both restore dynamic knee function: a randomized clinical trial-part II: Knee kinematics. Knee Surg Sports Traumatol Arthrosc 29(8):2676–2683CrossRefPubMedPubMedCentral

30.

Van de Velde SK, Gill TJ, DeFrate LE, Papannagari R, Li G (2008) The effect of anterior cruciate ligament deficiency and reconstruction on the patellofemoral joint. Am J Sports Med 36(6):1150–1159CrossRefPubMedPubMedCentral

31.

Wang HJ, Ao YF, Jiang D, Gong X, Wang YJ, Wang J, Yu JK (2015) Relationship between quadriceps strength and patellofemoral joint chondral lesions after anterior cruciate ligament reconstruction. Am J Sports Med 43(9):2286–2292CrossRefPubMed

32.

Xie D, Tanaka M, Pedoia V, Li AK, Facchetti L, Neumann J, Lartey R, Souza RB, Link TM, Benjamin Ma C, Li X (2023) Baseline cartilage T1ρ and T2 predicted patellofemoral joint cartilage lesion progression and patient-reported outcomes after ACL reconstruction. J Orthop Res 41(6):1310–1319CrossRefPubMed

33.

Xie X, Liu X, Chen Z, Yu Y, Peng S, Li Q (2015) A meta-analysis of bone-patellar tendon-bone autograft versus four-strand hamstring tendon autograft for anterior cruciate ligament reconstruction. Knee 22(2):100–110CrossRefPubMed

Title: Postoperative quadriceps weakness and male sex are risk factors for patellofemoral articular cartilage lesions after anatomical anterior cruciate ligament reconstruction
Authors: Ryo Murakami
Shuji Taketomi
Ryota Yamagami
Kenichi Kono
Kohei Kawaguchi
Tomofumi Kage
Takahiro Arakawa
Hiroshi Inui
Sakae Tanaka
Publication date: 26-10-2023
Publisher: Springer Berlin Heidelberg
Keywords: Arthroscopy
Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-023-07633-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Postoperative quadriceps weakness and male sex are risk factors for patellofemoral articular cartilage lesions after anatomical anterior cruciate ligament reconstruction

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 12/2023

Long-lasting decreased pain threshold negatively affects functional recovery after arthroscopic rotator cuff repair

Single-incision bone bridge lateral meniscus allograft transplantation: preserving neurovascular safety with promising results for posterior horn distortion and graft maturation

Satisfactory outcomes after one-stage revision anterior cruciate ligament reconstruction using rectangular tunnel technique

Central sensitization negatively influences the level of disability in female patients with anterior knee pain

The V angle compliments radiographic assessment of acute acromioclavicular joint dislocations by differentiating between Rockwood types III versus V and by considering dynamic horizontal translation in coronal radiographs

Comparative analysis of discoid lateral meniscus size: a distinction between symptomatic and asymptomatic cases