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. 2000 Aug;59(8):641–646. doi: 10.1136/ard.59.8.641

Early radiographic features in patients with anterior cruciate ligament rupture

J Buckland-Wright 1, J Lynch 1, B Dave 1
PMCID: PMC1753209  PMID: 10913063

Abstract

OBJECTIVE—To determine, in a preliminary cross sectional study of patients with anterior cruciate ligament (ACL) ruptured knees, which of the radiographic features—subchondral cortical plate thickness, trabecular sclerosis, and osteophytosis—appears before or in association with changes in joint space width (JSW) as a surrogate for articular cartilage thickness in patients with ruptured knees.
METHODS—19 patients (14 men), mean (95% CI) age 28.7 (23.6 to 33.8) years, had ACL rupture in one knee only, confirmed by arthroscopy. Anterior draw, Lachman's test, and pivot shift tests were performed and ×5 posteroanterior macroradiographs of both knees in a standing semiflexed view were taken at a mean (95% CI) time from injury of 34.3 (26.9 to 41.7) months. In each radiograph, computerised methods were used to measure minimum JSW and fractal signature analysis (FSA) to quantify the vertical and horizontal trabecular organisation, osteophyte area, and the subchondral cortical plate thickness, in the medial and lateral tibial compartments of all knees.
RESULTS—Physical examination confirmed the presence of joint laxity in the injured knees. No statistical difference in either medial or lateral JSW and subchondral cortical plate thickness was detected between ACL ruptured and uninjured knees. FSA showed a significant decrease in fractal dimension for the horizontal trabeculae (size 0.42 mm) in the medial compartment of the ACL ruptured knees compared with the uninjured knees (p<0.01, multivariate analysis of variance). There was an inverse correlation (R −0.74) between the time since knee injury and the difference in FSA values for ACL ruptured and uninjured knees in medial compartment horizontal trabeculae (size 0.4 mm). No significant changes were detected in the lateral compartment. Osteophytes were detected in the medial compartment of nine ACL injured knees.
CONCLUSION—Compared with the uninjured knee, ACL rupture leads to thickening of subchondral horizontal trabeculae (decreased FSA) in the medial tibial compartment of all knees, reaching significance at about four years after injury. Osteophytes were present in the same compartment in 9/19 knees. No changes in JSW and subchondral cortical plate thickness were detected. Whether the bony changes detected in these ACL ruptured knees presage those of early osteoarthritis requires further study.



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Figure 1  .

Figure 1  

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Part of a computer screen showing a digitised macroradiograph of a knee. The region of interest used for calculating the fractal signature of the tibial cancellous bone in the medial compartment is outlined in white; the horizontal black line defines the floor of the tibial plateau.

Figure 2  .

Figure 2  

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Mean (SEM) of the medial compartment fractal signature analysis of horizontal trabecular structures in the ACL injured and uninjured knees; the difference was significant (p<0.01, multivariate analysis of variance with repeat measures).

Figure 3  .

Figure 3  

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Mean (95% CI) difference in medial compartment fractal signature analysis of horizontal trabecular structure between ACL ruptured and contralateral (uninjured) knee. *Indicates the trabecular structures of 0.4 mm in dimension that were significantly thicker in ACL ruptured knees (p<0.05) than in the uninjured knees.

Figure 4  .

Figure 4  

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Difference in medial compartment fractal signature analysis (FSA) value for horizontal trabecular structures at 0.4 mm size between ACL ruptured and contralateral (uninjured) knee in each patient plotted against time since injury. The magnitude of the difference in FSA correlated significantly with time since injury (R=−0.74, p<0.01).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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