Chronic ACLD Knees with Early Developmental Cartilage Lesions Exhibited Increased Posterior Tibial Translation during Level Walking

Abstract

Objective: Early articular cartilage lesion (CL) is a vital sign in the onset of posttraumatic knee osteoarthritis (PTOA) in patients with anterior cruciate ligament deficiency (ACLD). Researchers have suggested that altered kinematics could accelerate CLs and, therefore, lead to the onset of PTOA. However, little is known about whether specific knee kinematics exist that lead to early CL in chronic ACLD knees. Level walking is the most frequent and relevant in vivo activity, which greatly impacts knee health. We hypothesized that the knee kinematics during level walking in chronic ACLD knees with early tibiofemoral CL would significantly differ from those of chronic ACLD knees without early tibiofemoral CL.

Methods: Thirty patients with a chronic ACLD history, including 18 subjects with CLs and 12 subjects without CLs, and 35 healthy control subjects were recruited for the study from July 2020 to August 2022. The knee kinematic data during level walking were collected using a three-dimensional motion analysis system. The kinematic differences between groups were compared using statistical parametric mapping with one dimension for One-Way ANOVA. The cartilage statuses of the ACLD knees were assessed via MRI examination. The CLs distribution of subjects was evaluated using a modified Noyes scale and analyzed by chi-square tests.

Results: ACLD knees with CLs had significantly greater posterior tibial translation (7.7-8.0mm, 12%-18% gait cycle GC, p = 0.014) compared to ACLD knees without CLs during level walking. ACLD knees with CLs had greater posterior tibial translation (4.6-5.5mm, 0%-23% GC, p < 0.001; 5.8-8.0mm, 86%-100% GC, p < 0.001) than healthy controls during level walking. In the group of ACLD knees with CLs, CL is mainly located in the back of the tibia plateau and front of load bearing area of the medial femoral condyle (p < 0.05).

Conclusion: Chronic anterior cruciate ligament deficient knees with cartilage lesions have increased posterior tibial translation compared to anterior cruciate ligament deficient knees without cartilage lesions and healthy subjects. The posterior tibial translation may play an important role in knee cartilage degeneration in ACLD knees. The increased posterior tibial translation and cartilage lesion characteristics may improve our understanding of the role of knee kinematics in cartilage degeneration and could be a helpful potential reference for anterior cruciate ligament deficient therapy, such as physical training to improve abnormal kinematic behavior.

Keywords: Anterior Cruciate Ligament Deficiency; Cartilage Lesion; Knee Kinematics; Level Walking; Post‐Traumatic Knee Osteoarthritis.

FIGURE 1

Flow diagram of the study.

Figure 2

Diagram of the subareas of tibiofemoral cartilage. To assess cartilage lesion distribution, the femoral condyles and tibia plateau were divided into several subareas. Chart A showed the sagittal plane of the subareas. Charts B and C were the diagrams of the subareas of the femoral condyles. Combining the abbreviations used for the subareas of the femoral condyles and tibia plateau, the first letter represented the compartments (M for the medial compartment, L for the lateral compartments). The second letter represented the condyle or plateau (F for femoral condyle and T for tibia plateau). The final number represented the area marked on Chart A (1 for anterior, 2 for middle, 3 for posterior).

FIGURE 3

Chart of sagittal knee kinematics during level walking. Charts A&F showed the alterations of sagittal knee kinematics. Charts B–E & G–J showed the statistical values of SPM analysis. * indicates that significant alterations (p < 0.05) were found between ACLD knees with CL and ACLD knees without CL. + indicated that significant alterations (p < 0.05) were found between ACLD knees with CL and those of healthy controls. The numbers below/above the symbols represented the magnitude range of kinematics differences between the groups.

FIGURE 4

Chart of coronal knee kinematics during level walking. Charts A&F showed the alterations of coronal knee kinematics. Charts B–E & G–J showed the statistical values of SPM analysis. The results showed that there were no significant differences in knee kinematics between groups in the coronal plane.

FIGURE 5

Chart of transverse knee kinematics during level walking. Charts A&F showed the alterations of transverse knee kinematics. Charts B‐E & G‐J showed the statistical values of SPM analysis. The results showed that there were no significant differences of knee kinematics between groups in transverse plane.

FIGURE 6

Chart of range of motion of knee kinematics during level walking. # indicated that significant alterations (p < 0.05) were found between ACLD knees without CL and those of healthy controls. + indicated that significant alterations (p < 0.05) were found between ACLD knees with CL and those of healthy controls.