MRT-basierte Knorpelvolumetrie nach Kreuzbandersatzplastik in Korrelation mit qualitativen Gelenkveränderungen und dem klinischen Outcome. Gibt es Hinweise auf frühzeitige posttraumatische degenerative Veränderungen?

 

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Zusammenfassung

Ziel: Ziel unserer Pilotstudie war es zu untersuchen, welche quantitativen und qualitativen, auf eine frühe posttraumatische OA-Entstehung hinweisende, Veränderungen des Knieknorpels und -gelenks 4 Jahre nach einer VKB-Ersatzplastik mittels der MRT erfasst werden können und wie diese mit dem klinischen Outcome (CO) korrelieren. Material und Methoden:9 Patienten wurden post-OP und 4 Jahre später bei 1,5 T untersucht. Mittels einer hochauflösenden T 1-w-fs-FLASH-3D-Sequenz erfolgte eine quantitative Bestimmung des Knorpelvolumens (cVol) und der mittleren Knorpeldicke (mTh) des retropatellaren, femoralen und tibialen Gelenkknorpels. Anhand PD-w-fs und T 1-w-fs Sequenzen wurden qualitative Veränderungen der gelenkbildenden Strukturen auf der Basis des WORMS-Score ermittelt. Das CO wurde von einem erfahrenen Orthopäden in folgenden Tests erhoben: Lysholm-Score, OAK-Score, Tegner-Aktivitäts-Score (TAS) und Arthrometer KT-1000-Test. Ergebnisse: Die mittlere Änderung des cVol betrug ca. –1,8 % (range: –5,9 %; + 0,7 %), die der mTh ca. –0,8 % (range: –3,0 %; + 1,1 %). In keinem Kompartiment erwiesen sich die Änderungen als signifikant (95 %-KI). 3 Patienten zeigten neue peripatellare Osteophyten, akute traumaassoziierte Veränderungen waren insgesamt deutlich seltener. CO: Der Lysholm- und OAK-Score betrug im Mittel 90 bzw. 86 Pkt. Der TAS betrug im Mittel 4,3 Pkt. Die mittlere max. tibiale Translation lag bei 5,2 mm (gesunde Gegenseite 6,7 mm). Schlussfolgerung: 4 Jahre nach VKB-Ersatzplastik konnten mit der qMRT im Kniegelenk eine Tendenz hin zu kleineren Werten jedoch keine signifikanten Veränderungen des cVol und der mTh gemessen werden. Neue Osteophyten als morphologische Hinweise auf eine OA korrelierten nicht mit dem überwiegend guten CO. Unserer durch die Kollektivgröße limitierten Studie sollten weitere quantitative und semiquantitative, strukturelle MRT-Untersuchungen des Knorpels und Knochens folgen um die frühzeitige diagnostische Erfassung einer OA-Entstehung weiter voranzutreiben.

Abstract

Purpose: The purpose of this study was to analyze potential quantitative and qualitative changes of the knee cartilage and joint indicative of early posttraumatic OA 4 years after ACL-reconstruction and to correlate the MRI-findings with the clinical outcome (CO). Materials and Methods: 1.5 T MRI-scans were performed on 9 patients post-op and 4 years later. Using a high-resolution T 1-w-fs-FLASH-3D-sequence cartilage volume (cVol) and thickness (mTh) were quantified. Using standard PD-w fs and T 1-w sequences qualitative changes of the joint structures were analyzed based on the WORMS-score. CO was rated by an orthopaedic surgeon using Lysholm-score, OAK-score, Tegner-activity-score (TAS), and Arthrometer KT-1000 testing. Results: Mean changes of cVol were –1.8 % (range: –5.9 %; + 0.7 %) and of mTh –0.8 % (range: –3.0 %; + 1.1 %). No significant change (95 %-CI) could be identified for any compartment. Three patients developed new peripatellar ostheophytes, acute trauma related changes mostly decreased. Mean outcome of Lysholm-score and OAK-score were 90 pts and 86 pts, mean TAS was 4.3 pts. Average maximum tibial translation reached 5.2 mm comparing to 6.7 mm on the healthy contralateral side. Conclusion: Despite a tendency towards decreased cVol and mTh 4 years after ACL-reconstruction qMRI revealed no significant cartilage loss. Newly developing osteophytes did not match with the observed good CO. This small pilot study motivates future quantitative and qualitative-structural MRI-based assessment of articular cartilage and other joint structures in order to improve diagnostic tools for the detection of early OA.

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Andreas Paul Arnoldi

Department of Clinical Radiologie, LMU München

Marchioninistrasse 15

81377 München

Phone:  ++ 49/89/70 95 36 20

Fax:  ++ 49/89/70 95 88 32

Email: andreas.arnoldi@med.uni-muenchen.de