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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2019

01-08-2019 | KNEE

Quadriceps weakness associates with greater T1ρ relaxation time in the medial femoral articular cartilage 6 months following anterior cruciate ligament reconstruction

Authors: Brian Pietrosimone, Steven J. Pfeiffer, Matthew S. Harkey, Kyle Wallace, Christian Hunt, J. Troy Blackburn, Randy Schmitz, David Lalush, Daniel Nissman, Jeffrey T. Spang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2019

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Abstract

Purpose

Quadriceps weakness following anterior cruciate ligament reconstruction (ACLR) is linked to decreased patient-reported function, altered lower extremity biomechanics and tibiofemoral joint space narrowing. It remains unknown if quadriceps weakness is associated with early deleterious changes to femoral cartilage composition that are suggestive of posttraumatic osteoarthritis development. The purpose of the cross-sectional study was to determine if quadriceps strength was associated with T1ρ relaxation times, a marker of proteoglycan density, of the articular cartilage in the medial and lateral femoral condyles 6 months following ACLR. It is hypothesized that individuals with weaker quadriceps would demonstrate lesser proteoglycan density.

Methods

Twenty-seven individuals (15 females, 12 males) with a patellar tendon autograft ACLR underwent isometric quadriceps strength assessments in 90°of knee flexion during a 6-month follow-up exam. Magnetic resonance images (MRI) were collected bilaterally and voxel by voxel T1ρ relaxation times were calculated using a five-image sequence and a monoexponential equation. Following image registration, the articular cartilage for the weight-bearing surfaces of the medial and lateral femoral condyles (MFC and LFC) were manually segmented and further sub-sectioned into posterior, central and anterior regions of interest (ROI) based on the corresponding meniscal anatomy viewed in the sagittal plane. Univariate linear regression models were used to determine the association between quadriceps strength and T1ρ relaxation times in the entire weight-bearing MFC and LFC, as well as the ROI in each respective limb.

Results

Lesser quadriceps strength was significantly associated with greater T1ρ relaxation times in the entire weight-bearing MFC (R2 = 0.14, P = 0.05) and the anterior-MFC ROI (R2 = 0.22, P = 0.02) of the ACLR limb. A post hoc analysis found lesser strength and greater T1ρ relaxation times were significantly associated in a subsection of participants (n = 18) without a concomitant medial tibiofemoral compartment meniscal or chondral injury in the entire weight-bearing MFC, as well as anterior-MFC and central-MFC ROI of the ACLR and uninjured limb.

Conclusions

The association between weaker quadriceps and greater T1ρ relaxation times in the MFC suggests deficits in lower extremity muscle strength may be related to cartilage composition as early as 6 months following ACLR. Maximizing quadriceps strength in the first 6 months following ACLR may be critical for promoting cartilage health early following ACLR.

Level of evidence

Prognostic level 1.
Literature
1.
Andriacchi TP, Briant PL, Bevill SL, Koo S (2006) Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res 442:39–44CrossRefPubMed
2.
Blackburn JT, Pietrosimone B, Harkey MS, Luc BA, Pamukoff DN (2016) Quadriceps function and gait kinetics after anterior cruciate ligament reconstruction. Med Sci Sports Exerc 48(9):1664–1670CrossRefPubMed
3.
Faul F, Erdfelder E, Lang AG, A B (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191CrossRefPubMed
4.
Fedorov A, Beichel R, Kalpathy-Cramer J, Finet J, Fillion-Robin JC, Pujol S, Bauer C, Jennings D, Fennessy F, Sonka M, Buatti J, Aylward S, Miller JV, Pieper S, Kikinis R (2012) 3D slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 30(9):1323–1341CrossRefPubMedPubMedCentral
5.
Hatcher CC, Collins AT, Kim SY, Michel LC, Mostertz WC III, Ziemian SN, Spritzer CE, Guilak F, DeFrate LE, McNulty AL (2017) Relationship between T1rho magnetic resonance imaging, synovial fluid biomarkers, and the biochemical and biomechanical properties of cartilage. J Biomech 55:18–26CrossRefPubMedPubMedCentral
6.
Hirose J, Nishioka H, Okamoto N, Oniki Y, Nakamura E, Yamashita Y, Usuku K, Mizuta H (2013) Articular cartilage lesions increase early cartilage degeneration in knees treated by anterior cruciate ligament reconstruction: T1rho mapping evaluation and 1-year follow-up. Am J Sports Med 41(10):2353–2361CrossRefPubMed
7.
Kumar D, Su F, Wu D, Pedoia V, Heitkamp L, Ma CB, Souza RB, Li X (2017) Frontal plane knee mechanics and early cartilage degeneration in people with anterior cruciate ligament reconstruction: a longitudinal study. Am J Sports Med 46(2):378–387CrossRefPubMed
8.
Lepley A, Ericksen H, Sohn D, Pietrosimone B (2014) Contributions of neural excitability and voluntary activation to quadriceps muscle strength following anterior cruciate ligament reconstruction. Knee 21(3):736–742CrossRefPubMed
9.
Lepley AS, Gribble PA, Thomas AC, Tevald MA, Sohn DH, Pietrosimone BG (2015) Quadriceps neural alterations in anterior cruciate ligament reconstructed patients: a 6-month longitudinal investigation. Scand J Med Sci Sports 25(6):828–839CrossRefPubMed
10.
Lepley LK (2015) Deficits in quadriceps strength and patient-oriented outcomes at return to activity after ACL reconstruction: a review of the current literature. Sports Health 7(3):231–238CrossRefPubMedPubMedCentral
11.
Lepley LK, Palmieri-Smith RM (2015) Quadriceps strength, muscle activation failure, and patient-reported function at the time of return to activity in patients following anterior cruciate ligament reconstruction: a cross-sectional study. J Orthop Sports Phys Ther 45(12):1017–1025CrossRefPubMedPubMedCentral
12.
Lewek M, Rudolph K, Axe M, Snyder-Mackler L (2002) The effect of insufficient quadriceps strength on gait after anterior cruciate ligament reconstruction. Clin Biomech (Bristol Avon) 17(1):56–63CrossRef
13.
Li X, Kuo D, Theologis A, Carballido-Gamio J, Stehling C, Link TM, Ma CB, Majumdar S (2011) Cartilage in anterior cruciate ligament-reconstructed knees: MR imaging T1{rho} and T2–initial experience with 1-year follow-up. Radiology 258(2):505–514CrossRefPubMedPubMedCentral
14.
Lohmander S (1988) Proteoglycans of joint cartilage. Structure, function, turnover and role as markers of joint disease. Baillieres Clin Rheumatol 2(1):37–62CrossRefPubMed
15.
Luc B, Gribble P, Pietrosimone B (2014) Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers needed to treat analysis. J Athl Train 49(6):806–819CrossRefPubMedPubMedCentral
16.
Luc BA, Harkey MH, Arguelles GD, Blackburn JT, Ryan ED, Pietrosimone B (2016) Measuring voluntary quadriceps activation: effect of visual feedback and stimulus delivery. J J Electromyogr Kinesiol 26:73–81CrossRef
17.
Luc-Harkey BA, Franz JR, Blackburn JT, Padua DA, Hackney AC, Pietrosimone B (2018) Real-time biofeedback can increase and decrease vertical ground reaction force, knee flexion excursion, and knee extension moment during walking in individuals with anterior cruciate ligament reconstruction. J Biomech 76:94–102CrossRefPubMed
18.
Macias-Hernandez SI, Miranda-Duarte A, Ramirez-Mora I, Cortes-Gonzalez S, Morones-Alba JD, Olascoaga-Gomez A, Coronado-Zarco R, Soria-Bastida Mde L, Nava-Bringas TI, Cruz-Medina E (2016) Knee muscle strength correlates with joint cartilage T2 relaxation time in young participants with risk factors for osteoarthritis. Clin Rheumatol 35(8):2087–2092CrossRefPubMed
19.
Nawasreh Z, Logerstedt D, Cummer K, Axe MJ, Risberg MA, Snyder-Mackler L (2017) Do patients failing return-to-activity criteria at 6 months after anterior cruciate ligament reconstruction continue demonstrating deficits at 2 years? Am J Sports Med 45(5):1037–1048CrossRefPubMed
20.
Osaki K, Okazaki K, Takayama Y, Matsubara H, Kuwashima U, Murakami K, Doi T, Matsuo Y, Honda H, Iwamoto Y (2015) Characterization of biochemical cartilage change after anterior cruciate ligament injury using T1rho mapping magnetic resonance imaging. Orthop J Sports Med 3(5):2325967115585092CrossRefPubMedPubMedCentral
21.
Palmieri-Smith R, Thomas A (2009) A neuromuscular mechanism of posttraumatic osteoarthritis associated with ACL injury. Exerc Sports Sci Rev 37:147–153CrossRef
22.
Palmieri-Smith R, Thomas A, Wojtys E (2008) Maximizing quadriceps strength after ACL reconstruction. Clin Sports Med 27(3):405–425CrossRefPubMed
23.
Pfeiffer S, Harkey MS, Stanley LE, Blackburn JT, Padua DA, Spang JT, Marshall SW, Jordan JM, Schmitz R, Nissman D, Pietrosimone B (2018) Associations between slower walking speed and T1rho magnetic resonance imaging of femoral cartilage following anterior cruciate ligament reconstruction. Arthritis Care Res (Hoboken) 70(8):1132–1140CrossRef
24.
Pietrosimone B, Lepley AS, Harkey MS, Luc-Harkey BA, Blackburn JT, Gribble PA, Spang JT, Sohn DH (2016) Quadriceps strength predicts self-reported function post-ACL reconstruction. Med Sci Sport Exerc 48(9):1671–1677CrossRef
25.
Pietrosimone B, Loeser RF, Blackburn JT, Padua DA, Harkey MS, Stanley LE, Luc-Harkey BA, Ulici V, Marshall SW, Jordan JM, Spang JT (2017) Biochemical markers of cartilage metabolism are associated with walking biomechanics 6-months following anterior cruciate ligament reconstruction. J Orthop Res 35(10):2288–2297CrossRefPubMedPubMedCentral
26.
Pietrosimone B, Nissman D, Blackburn JT, Harkey MH, Creighton A, Kamath G, Healy K, Schmitz R, Driban JB, Padua DA, Marshall SW, Jordan JM, Spang JT (2018) Associations between cartilage proteoglycan density and patient outcomes 12 months following anterior cruciate ligament reconstruction. Knee 25(1):118–129CrossRefPubMed
27.
Pietrosimone BG, Lepley AS, Ericksen HM, Gribble PA, Levine J (2013) Quadriceps strength and corticospinal excitability as predictors of disability after anterior cruciate ligament reconstruction. J Sport Rehabil 22(1):1–6CrossRefPubMed
28.
Pietrosimone BG, Saliba SA, Hart JM, Hertel J, Kerrigan DC, Ingersoll CD (2010) Effects of disinhibitory transcutaneous electrical nerve stimulation and therapeutic exercise on sagittal plane peak knee kinematics and kinetics in people with knee osteoarthritis during gait: a randomized controlled trial. Clin Rehabil 24:1091–1101CrossRefPubMed
29.
Radin E, Martin R, Burr D, Caterson B, Boyd R, Goodwin C (1984) Effects of mechanical loading on the tissues of the rabbit knee. J Orthop Res 2(3):221–234CrossRefPubMed
30.
Rautiainen J, Nissi M, Salo E, Tiitu V, Finnilä M, Aho O, Saarakkala S, Lehenkari P, Ellermann J, Nieminen M (2014) Multiparametric MRI assessment of human articular cartilage degeneration: correlation with quantitative histology and mechanical properties. Mag Reson Med. https://​doi.​org/​10.​1002/​mrm.​25401 CrossRef
31.
Roberts D, Kuenze C, Saliba S, Hart JM (2012) Accessory muscle activation during the superimposed burst technique. J Electromyogr Kinesiol 22(4):540–545CrossRefPubMed
32.
Souza RB, Stehling C, Wyman BT, Hellio Le Graverand MP, Li X, Link TM, Majumdar S (2010) The effects of acute loading on T1rho and T2 relaxation times of tibiofemoral articular cartilage. Osteoarthr Cartil 18(12):1557–1563CrossRefPubMed
33.
Su F, Hilton JF, Nardo L, Wu S, Liang F, Link TM, Ma CB, Li X (2013) Cartilage morphology and T1rho and T2 quantification in ACL-reconstructed knees: a 2-year follow-up. Osteoarthr Cartil 21(8):1058–1067CrossRefPubMedPubMedCentral
34.
Su F, Pedoia V, Teng HL, Kretzschmar M, Lau BC, McCulloch CE, Link TM, Ma CB, Li X (2016) The association between MR T1rho and T2 of cartilage and patient-reported outcomes after ACL injury and reconstruction. Osteoarthr Cartil 24(7):1180–1189CrossRefPubMedPubMedCentral
35.
Teng HL, Wu D, Su F, Pedoia V, Souza RB, Ma CB, Li X (2017) Gait characteristics associated with a greater increase in medial knee cartilage T1rho and T2 relaxation times in patients undergoing anterior cruciate ligament reconstruction. Am J Sports Med 45(14):3262–3271CrossRefPubMed
36.
Theologis A, Kuo D, Cheng J, Bolbos R, Carballido-Gamio J, Ma C, Li X (2011) Evaluation of bone bruises and associated cartilage in anterior cruciate ligament-injured and -reconstructed knees using quantitative t(1ρ) magnetic resonance imaging: 1-year cohort study. Arthroscopy 27(1):65–76CrossRefPubMed
37.
Theologis AA, Haughom B, Liang F, Zhang Y, Majumdar S, Link TM, Ma CB, Li X (2014) Comparison of T1rho relaxation times between ACL-reconstructed knees and contralateral uninjured knees. Knee Surg Sports Traumatol Arthrosc 22(2):298–307CrossRefPubMed
38.
Tourville TW, Jarrell KM, Naud S, Slauterbeck JR, Johnson RJ, Beynnon BD (2014) Relationship between isokinetic strength and tibiofemoral joint space width changes after anterior cruciate ligament reconstruction. Am J Sports Med 42(2):302–311CrossRefPubMed
39.
Wheaton AJ, Casey FL, Gougoutas AJ, Dodge GR, Borthakur A, Lonner JH, Schumacher HR, Reddy R (2004) Correlation of T1rho with fixed charge density in cartilage. Magn Reson Imaging 20(3):519–525CrossRef
40.
Yushkevich PA, Piven J, Hazlett HC, Smith RG, Ho S, Gee JC, Gerig G (2006) User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 31(3):1116–1128CrossRefPubMed
41.
Zwolski C, Schmitt LC, Quatman-Yates C, Thomas S, Hewett TE, Paterno MV (2015) The influence of quadriceps strength asymmetry on patient-reported function at time of return to sport after anterior cruciate ligament reconstruction. Am J Sports Med 43(9):2242–2249CrossRefPubMed
Metadata
Title
Quadriceps weakness associates with greater T1ρ relaxation time in the medial femoral articular cartilage 6 months following anterior cruciate ligament reconstruction
Authors
Brian Pietrosimone
Steven J. Pfeiffer
Matthew S. Harkey
Kyle Wallace
Christian Hunt
J. Troy Blackburn
Randy Schmitz
David Lalush
Daniel Nissman
Jeffrey T. Spang
Publication date
01-08-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5290-y

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