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Return To Motion, Risk To Ptoa: Cartilage Arthrokinematics And Quantitative Mri After Acl Reconstruction With Meniscal Surgery
Khodabandeloo, Sadegh
Khodabandeloo, Sadegh
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Abstract
Post-traumatic osteoarthritis (PTOA) is common disease following anterior cruciate ligament reconstruction (ACLR), affecting more than 50% of the patients that suffer this injury 10-15 years post-surgery. The prevalence of PTOA is greater when ACLR is combined with meniscal surgery (ACLR+M). Despite the epidemiological data, the mechanism underlying development of PTOA remains poorly understood. A long-standing hypothesis suggests abnormal knee joint mechanics after ACLR surgery induce deleterious compositional changes in articular cartilage, but this framework has limited in-vivo evidence, especially in the ACLR+M population. This dissertation investigated how ACLR+M affects knee osteokinematics, cartilage arthrokinematics, and cartilage composition during the early postoperative years following ACLR. In addition, we explored whether these alterations evolve over time and hold promise as predictors of biomarkers associated with the onset and development of PTOA.A longitudinal, multimodal approach combining dual-fluoroscopy with model-based tracking (DF-MBT) and quantitative MRI (qMRI) assessed both the mechanical behavior of the joint and the compositional status of cartilage. Fifteen patients were imaged 1–2 years post-ACLR+M, with a subset of 10 returning at 2–3 years. DF-MBT quantified osteokinematics and cartilage arthrokinematics during walking, jogging, single-legged landing, lunging, and pivoting. Cartilage composition was measured with qMRI, specifically T1ρ and ultrashort echo time T2* (UTE-T2*) mapping, both with and without compressive load applied superiorly at the plantar aspect of the foot. Across studies, ACLR+M knees exhibited persistent anterior and lateral tibial translations, posterior directed shift of tibiofemoral contact on the tibial plateaus, and increased tibiofemoral contact overlap during gait and high-demand activities relative to contralateral knees. Cartilage composition was altered early in the ACLR+M knees, with elevated femoral T1ρ relaxation time values indicating proteoglycan depletion. qMRI with 50% BW compressive load applied to the knee revealed opposing femoral (T1ρ increase) and tibial (T1ρ decrease) responses when considering all knees as a combined group. Longitudinally, there was an increase in the medial tibial T1ρ relaxation times suggesting progressive cartilage degeneration and proteoglycan loss, and femoral UTE-T2* values normalized suggesting partial recovery of collagen integrity. Side-to-side differences in arthrokinematics at the 1-2-year timepoint were correlated with longitudinal changes in T1ρ relaxation times. In conclusion, this dissertation provides new evidence that subtle, persistent side-to-side differences in cartilage arthrokinematics, such as posterior shift in tibiofemoral contact locations on the tibia and an elevation in overlapping contact, following ACLR+M lead to compartment-specific alterations in cartilage composition between 1 and 3 years of ACLR. The integration of DF-MBT during dynamic activities and qMRI with and without compressive load applied to the knee establishes a powerful mechanics-to-biology framework for detecting potential early biomarkers for the long-term onset of PTOA. These findings highlight the potential of advanced imaging to identify at-risk patients and to guide personalized rehabilitation with early intervention strategies aimed at preserving cartilage health after ACLR+M.
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2026
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Khodabandeloo_uvm_0243D_11971.pdf
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- Embargoed until 2026-12-19