Quantitative MRI Biomarkers to Predict Risk of Reinjury Within 2 Years After Bridge-Enhanced ACL Restoration

Medientyp: E-Artikel
Titel: Quantitative MRI Biomarkers to Predict Risk of Reinjury Within 2 Years After Bridge-Enhanced ACL Restoration
Beteiligte: Barnes, Dominique A.; Badger, Gary J.; Yen, Yi-Meng; Micheli, Lyle J.; Kramer, Dennis E.; Fadale, Paul D.; Hulstyn, Michael J.; Owens, Brett D.; Flannery, Sean W.; Ecklund, Kirsten; Sanborn, Ryan M.; Costa, Meggin Q.; Chrostek, Cynthia; Proffen, Benedikt L.; Sant, Nicholas; Murray, Martha M.; Fleming, Braden C.; Kiapour, Ata M.
Erschienen: SAGE Publications, 2023
Erschienen in: The American Journal of Sports Medicine
Sprache: Englisch
DOI: 10.1177/03635465221142323
ISSN: 0363-5465; 1552-3365
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Beschreibung: <jats:sec><jats:title>Background:</jats:title><jats:p> Quantitative magnetic resonance imaging (qMRI) methods were developed to establish the integrity of healing anterior cruciate ligaments (ACLs) and grafts. Whether qMRI variables predict risk of reinjury is unknown. </jats:p></jats:sec><jats:sec><jats:title>Purpose:</jats:title><jats:p> To determine if qMRI measures at 6 to 9 months after bridge-enhanced ACL restoration (BEAR) can predict the risk of revision surgery within 2 years of the index procedure. </jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p> Cohort study; Level of evidence, 2. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> Originally, 124 patients underwent ACL restoration as part of the BEAR I, BEAR II, and BEAR III prospective trials and had consented to undergo an MRI of the surgical knee 6 to 9 months after surgery. Only 1 participant was lost to follow-up, and 4 did not undergo MRI, leaving a total of 119 patients for this study. qMRI techniques were used to determine the mean cross-sectional area; normalized signal intensity; and a qMRI-based predicted failure load, which was calculated using a prespecified equation based on cross-sectional area and normalized signal intensity. Patient-reported outcomes (International Knee Documentation Committee subjective score), clinical measures (hamstring strength, quadriceps strength, and side-to-side knee laxity), and functional outcomes (single-leg hop) were also measured at 6 to 9 months after surgery. Univariate and multivariable analyses were performed to determine the odds ratios (ORs) for revision surgery based on the qMRI and non-imaging variables. Patient age and medial posterior tibial slope values were included as covariates. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> In total, 119 patients (97%), with a median age of 17.6 years, underwent MRI between 6 and 9 months postoperatively. Sixteen of 119 patients (13%) required revision ACL surgery. In univariate analyses, higher International Knee Documentation Committee subjective score at 6 to 9 months postoperatively (OR = 1.66 per 10-point increase; P = .035) and lower qMRI-based predicted failure load (OR = 0.66 per 100-N increase; P = .014) were associated with increased risk of revision surgery. In the multivariable model, when adjusted for age and posterior tibial slope, the qMRI-based predicted failure load was the only significant predictor of revision surgery (OR = 0.71 per 100 N; P = .044). </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> Quantitative MRI-based predicted failure load of the healing ACL was a significant predictor of the risk of revision within 2 years after BEAR surgery. The current findings highlight the potential utility of early qMRI in the postoperative management of patients undergoing the BEAR procedure. </jats:p></jats:sec>

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