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Quantitative MRI Biomarkers to Predict Risk of Reinjury Within 2 Years After Bridge-Enhanced ACL Restoration.
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- Author(s): 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.
- Source:
American Journal of Sports Medicine; Feb2023, Vol. 51 Issue 2, p413-421, 9p- Subject Terms:
KNEE radiography; STATISTICS; WOUND healing; MULTIVARIATE analysis; AGE distribution; ANTERIOR cruciate ligament; MAGNETIC resonance imaging; HEALTH outcome assessment; RISK assessment; TREATMENT effectiveness; FUNCTIONAL assessment; REOPERATION; ANTERIOR cruciate ligament injuries; SIGNAL processing; HAMSTRING muscle; QUADRICEPS muscle; MUSCLE strength; QUESTIONNAIRES; ANTERIOR cruciate ligament surgery; BIOMECHANICS; LOGISTIC regression analysis; ODDS ratio; LONGITUDINAL method; TISSUE scaffolds - Source:
- Additional Information
- Abstract: Background: 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. Purpose: 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. Study Design: Cohort study; Level of evidence, 2. Methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]
- Abstract: Copyright of American Journal of Sports Medicine is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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