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Diffusion tensor imaging of the anterior cruciate ligament following primary repair with internal bracing: A longitudinal study.

Authors
  • Van Dyck, Pieter1
  • Froeling, Martijn2
  • Heusdens, Christiaan H W3
  • Sijbers, Jan4
  • Ribbens, Annemie5
  • Billiet, Thibo5
  • 1 Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium. , (Belgium)
  • 2 Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. , (Netherlands)
  • 3 Department of Orthopedics, Antwerp University Hospital, Edegem, Belgium. , (Belgium)
  • 4 Imec-Vision Lab, Department of Physics, University of Antwerp, Wilrijk, Belgium. , (Belgium)
  • 5 Icometrix, Leuven, Belgium. , (Belgium)
Type
Published Article
Journal
Journal of Orthopaedic Research®
Publisher
Wiley (John Wiley & Sons)
Publication Date
Jun 01, 2021
Volume
39
Issue
6
Pages
1318–1330
Identifiers
DOI: 10.1002/jor.24684
PMID: 32270563
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Diffusion tensor imaging (DTI) provides information about tissue microstructure and its degree of organization by quantifying water diffusion. We aimed to monitor longitudinal changes in DTI parameters (fractional isotropy, FA; mean diffusivity, MD; axial diffusivity, AD; radial diffusivity, RD) of the anterior cruciate ligament (ACL) following primary repair with internal bracing (IBLA). Fourteen patients undergoing IBLA were enrolled prospectively and scheduled for clinical follow-up, including instrumented laxity testing, and DTI at 3, 6, 12, and 24 months postoperatively. DTI was also performed in seven healthy subjects. Fiber tractography was used for 3D segmentation of the whole ACL volume, from which median DTI parameters were calculated. The posterior cruciate ligament (PCL) served as a control. Longitudinal DTI changes were assessed using a linear mixed model, and repeated measures correlations were calculated between DTI parameters and clinical laxity tests. At follow-up, thirteen patients had a stable knee and one patient sustained an ACL rerupture after 12 months postoperatively. The ACL repair showed a significant decrease of FA within the first 12 months after surgery, followed by stable FA values thereafter, while ACL diffusivities decreased over time returning towards normal values at 24 months postoperatively. For PCL there were no significant DTI changes over time. There was a significant correlation between ACL FA and laxity tests (r = -0.42, P = .017). This study has shown the potential of DTI to longitudinally monitor diffusion changes in the ACL following IBLA. The DTI findings suggest that healing of the ACL repair is incomplete at 24 months postoperatively. © 2020 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

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