Musculoskeletal and Emergency ImagingPostsurgical status of articular cartilage after arthroscopic posterior cruciate ligament reconstruction in patients with or without concomitant meniscal pathology
Introduction
Posterior cruciate ligament (PCL) injuries are rare, accounting for only 2% of all knee injuries.[1] The management of PCL injuries is still controversial, and numerous studies have shown good clinical results with non-surgical treatment.[2] However, several studies have reported that articular cartilage deteriorates over time with conservative treatment.3, 4, 5 PCL reconstruction (PCLR) is commonly believed to restore knee stability and reduce the risk of articular cartilage degeneration. The rate of the premature degenerative change after arthroscopic PCLR was reported to be 10% to 18% of patients, even though the stability of the knee was successfully restored.6, 7 Several prognostic factors may cause degenerative changes, of which concomitant meniscectomy has been reported to correlate with developmental cartilage damage after PCLR.8, 9 However, these studies used plain radiography to assess osteoarthritis outcome. Although radiography is the most common imaging modality for diagnosing degenerative arthritis, radiography has limited sensitivity for identifying early degenerative changes.10., 11. Magnetic resonance imaging (MRI) is the most reliable noninvasive imaging method for evaluating morphological changes in articular cartilage and has been an important tool in the study of osteoarthritis due to MRI's capability to visualize all structures of the knee joint. Michalitsis et al. reported that development of the new cartilage lesion after anterior cruciate ligament (ACL) reconstruction was evident as detected by MRI, and partial meniscectomy is a risk factor for the progression of chondral lesions.[12] We wondered if the outcome of PCL reconstruction with meniscectomy would give the same incidence and distribution of cartilage injury.
In this study, we investigated the presence and progression of articular cartilage lesions that can be seen on MRI after PCL reconstruction and evaluated whether concomitant meniscal pathology could be a risk factor for progression of cartilage damage in PCL reconstruction.
Section snippets
Case selection
Our hospital Institutional Review Board approved this study, and informed consent was waived due to the retrospective study design. From November 2011 to August 2017, we enrolled 85 consecutive patients into our study who diagnosed as PCL injury by initial knee MRI, then underwent arthroscopic PCLR and after then underwent follow up MRI of the knee in our hospital. We carry out regular follow-up MRI protocols within a year of arthroscopic reconstruction of the ACL or PCL. In clinical practice,
Results
The median follow-up period was 12 months (range, 6–88 months). Cartilage lesions were observed in 18 patients (27.7%) on last follow-up MRI compared to 11 patients (16.9%) on baseline MRI before PCLR. 11 patients (16.9%) demonstrated progression of articular cartilage lesions during follow-up MRI. Eight of these patients had new cartilage lesions, all of which were grade 2 or above. In the other three patients, grade 1 cartilage lesions deteriorated to grade 2. The majority of cartilage
Discussion
The most important finding of the present study was that patients with concomitant meniscal pathology who underwent meniscal surgery during PCLR are more likely to have progression of articular cartilage lesions compared to those with intact menisci. On follow-up MRI, articular cartilage lesions were more common in the medial tibiofemoral and patellofemoral compartments than in the lateral tibiofemoral compartment. Moreover, the progression of articular cartilage lesions was mostly in the
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