The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative,Journal of Orthopaedic Translation

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The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative
Journal of Orthopaedic Translation ( IF 5.9 ) Pub Date : 2023-12-14 , DOI: 10.1016/j.jot.2023.09.005
Ping Luo _{1,

2} , Qianyi Wang ₁ , Peihua Cao ₁ , Tianyu Chen ₃ , Shengfa Li ₁ , Xiaoshuai Wang ₁ , Yamin Li ₄ , Ze Gong ₅ , Yan Zhang ₁ , Guangfeng Ruan ₆ , Zuoqing Zhou ₇ , Yuanyuan Wang ₈ , Weiyu Han ₁ , Zhaohua Zhu ₁ , David J Hunter _{1,

9} , Jia Li ₁₀ , Changhai Ding _{1,

11}

Affiliation

Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Department of Spinal Surgery, The Fourth Hospital of Changsha, Changsha Hospital of Hunan Normal University, Changsha, Hunan, China.
Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Department of Nephrology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
Department of Orthopedics, The First Affiliated Hospital, Shaoyang University, Shaoyang, Hunan, China.
Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia.
Division of Orthopaedic Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.

Background

Though anterior cruciate ligament (ACL) tear has been widely accepted as an important accelerator for knee osteoarthritis (KOA), the role of intrinsic ACL degeneration in developing KOA has not been fully investigated.

Purpose

To determine whether ACL degeneration, in the absence of ACL tear, is associated with incident KOA over 4 years.

Study design

Cohort study; Level of evidence, 2.

Methods

Participants’ knees in this nested case–control study were selected from the Osteoarthritis Initiative (OAI) study, with Kellgren–Lawrence grading (Kellgren–Lawrence grading) of 0 or 1 at baseline (BL). Case knees which had incident KOA (KLG ≥2) over 4 years, were matched 1:1 with control knees by gender, age and radiographic status. ACL signal intensity alteration (0–3 scale) and volume were assessed as compositional feature and morphology of ACL degeneration, using knee MRI at P0 (time of onset of incident KOA), P-1 (1 year prior to P0) and baseline. Conditional logistic regression was applied to analyze the association between measures of ACL degeneration and incident KOA.

Results

337 case knees with incident KOA were matched to 337 control knees. Participants were mostly female (68.5%), with an average age of 59.9 years old. ACL signal intensity alterations at BL, P-1 and P0 were significantly associated with an increased odds of incident KOA respectively (all P for trend ≤0.001). In contrast, ACL volumes were not significantly associated with incident KOA at any time points.

Conclusions

ACL signal intensity alteration is associated with increased incident KOA over 4 years, whereas ACL volume is not.

The translational potential of this article: This paper focused on ACL signal intensity alteration which could better reflect ACL degeneration rather than ACL tear during the progression of KOA and explored this topic in a nested case–control study. Utilizing MR images from KOA participants, we extracted the imaging features of ACL. In addition, we established a semi-quantitative score for ACL signal intensity alteration and found a significant correlation between it and KOA incidence. Our findings confirmed that the more severe the ACL signal intensity alteration, the stronger relationship with the occurrence of KOA. This suggests that more emphasis should be placed on ACL degeneration rather than ACL integrity in the future.

中文翻译：

前十字韧带变性与膝骨关节炎之间的关联：来自骨关节炎倡议的数据

背景

尽管前交叉韧带 (ACL) 撕裂已被广泛认为是膝骨关节炎 (KOA) 的重要加速因素，但内在 ACL 变性在发展 KOA 中的作用尚未得到充分研究。

目的

确定在没有 ACL 撕裂的情况下 ACL 变性是否与 4 年多的 KOA 事件相关。

学习规划

队列研究；证据级别，2。

方法

这项巢式病例对照研究的参与者膝盖选自骨关节炎倡议 (OAI) 研究，基线 (BL) 的凯尔格伦 - 劳伦斯分级 (Kellgren - Lawrence 分级) 为 0 或 1。 4 年以上发生 KOA (KLG ≥2) 的病例膝盖与对照膝盖按性别、年龄和放射学状态进行 1:1 匹配。在 P0（KOA 发病时间）、P-1（P0 前 1 年）和基线时使用膝关节 MRI，将 ACL 信号强度变化（0-3 级）和体积评估为 ACL 变性的组成特征和形态。应用条件逻辑回归分析 ACL 变性测量与 KOA 事件之间的关联。

结果

337 个发生 KOA 的病例膝盖与 337 个对照膝盖相匹配。参与者以女性为主（68.5%），平均年龄59.9岁。 BL、P-1 和 P0 处的 ACL 信号强度变化分别与 KOA 发生几率增加显着相关（所有趋势P ≤0.001）。相比之下，在任何时间点，ACL 体积与 KOA 事件均无显着相关性。

结论

ACL 信号强度改变与 4 年来 KOA 发病率增加相关，而 ACL 体积则不然。

本文的转化潜力：本文重点关注 ACL 信号强度的变化，这种变化可以更好地反映 KOA 进展过程中的 ACL 退化而不是 ACL 撕裂，并在巢式病例对照研究中探讨了这一主题。利用 KOA 参与者的 MR 图像，我们提取了 ACL 的成像特征。此外，我们建立了 ACL 信号强度改变的半定量评分，并发现它与 KOA 发生率之间存在显着相关性。我们的研究结果证实，ACL 信号强度变化越严重，与 KOA 的发生关系越强。这表明未来应该更多地关注 ACL 退化而不是 ACL 完整性。

更新日期：2023-12-15

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