Longitudinal Changes in Medial Meniscal Extrusion After ACL Injury and Reconstruction and Its Relationship With Cartilage Degeneration Assessed Using MRI-Based T1ρ and T2 Analysis

Shotaro Watanabe; Gabby B Joseph; Dai Sato; Drew A Lansdown; Julio Brandao Guimaraes; Thomas M Link; Chunbong Benjamin Ma

doi:10.1177/03635465241305734

Longitudinal Changes in Medial Meniscal Extrusion After ACL Injury and Reconstruction and Its Relationship With Cartilage Degeneration Assessed Using MRI-Based T1ρ and T2 Analysis

Am J Sports Med. 2025 Jan 2:3635465241305734. doi: 10.1177/03635465241305734. Online ahead of print.

Authors

Shotaro Watanabe^{1

2}, Gabby B Joseph³, Dai Sato^{1

4}, Drew A Lansdown¹, Julio Brandao Guimaraes^{3

5

6}, Thomas M Link³, Chunbong Benjamin Ma¹

Affiliations

¹ Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
² Department of Orthopaedic Surgery, Graduate School of Medical and Pharmaceutical Sciences, Chiba University, Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.
³ Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.
⁴ Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
⁵ Department of Musculoskeletal Radiology, Fleury Medicina e Saúde, São Paulo, Brazil.
⁶ Department of Radiology, Universidade Federal de São Paulo, São Paulo, Brazil.

PMID: 39743985
DOI: 10.1177/03635465241305734

Abstract

Background: Anterior cruciate ligament (ACL) injury often leads to posttraumatic osteoarthritis (PTOA), despite ACL reconstruction (ACLR). Medial meniscal extrusion (MME) is implicated in PTOA progression but remains understudied after ACL injury and ACLR.

Hypothesis/purpose: It was hypothesized that MME would increase longitudinally after ACL injury and ACLR, with greater changes in the ipsilateral knee compared with the contralateral knee, leading to cartilage degeneration. The study aimed to assess MME 3 years after ACLR and its relationship with magnetic resonance imaging (MRI) T1ρ and T2 as cartilage degeneration markers.

Study design: Cohort study; Level of evidence, 2.

Methods: MME and relative percentage of extrusion (RPE) were measured on 3 coronal slices of 3-dimensional fast spin-echo images and the mean values were used. T1ρ and T2 sequences were obtained and cartilage compositional measurements were performed using in-house developed software with MATLAB. Mixed models were used to assess the longitudinal changes and linear regression was used to assess the relationships between RPE and T1ρ and T2 values.

Results: A total of 54 participants with unilateral ACL injuries underwent preoperative bilateral knee MRI. A total of 36 participants completed MR scans at 6 months and 3 years after ACLR. MME and RPE measurements demonstrated high reliability (ICC > 0.88 and > 0.91, respectively). The predicted values of MME and RPE from the mixed models showed that the ipsilateral side had significantly greater MME and RPE than the contralateral side at all 3 time points (P = .023 for MME; P = .013 for RPE at baseline; and P < .001 at 6 months and P < .001 at 3 years for both MME and RPE). The rate of change of MME and RPE on the ipsilateral side was significantly greater than that on the contralateral side (P < .001). Postoperative RPE was associated with T1ρ and T2 values in the posterior medial femoral condyle.

Conclusion: MME and RPE obtained pre- and postoperatively after ACLR on the ipsilateral side were significantly greater than those on the contralateral side, and the longitudinal increases on the ipsilateral side were greater than those on the contralateral side. Postoperative RPE was significantly associated with cartilage degeneration in the posterior medial femoral condyle.

Keywords: anterior cruciate ligament injury; anterior cruciate ligament reconstruction; medial meniscal extrusion; posttraumatic osteoarthritis; quantitative magnetic resonance imaging.