The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative

Ping Luo; Qianyi Wang; Peihua Cao; Tianyu Chen; Shengfa Li; Xiaoshuai Wang; Yamin Li; Ze Gong; Yan Zhang; Guangfeng Ruan; Zuoqing Zhou; Yuanyuan Wang; Weiyu Han; Zhaohua Zhu; David J Hunter; Jia Li; Changhai Ding

doi:10.1016/j.jot.2023.09.005

The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative

J Orthop Translat. 2023 Dec 14:44:1-8. doi: 10.1016/j.jot.2023.09.005. eCollection 2024 Jan.

Authors

Ping Luo^{1

2}, Qianyi Wang¹, Peihua Cao¹, Tianyu Chen³, Shengfa Li¹, Xiaoshuai Wang¹, Yamin Li⁴, Ze Gong⁵, Yan Zhang¹, Guangfeng Ruan⁶, Zuoqing Zhou⁷, Yuanyuan Wang⁸, Weiyu Han¹, Zhaohua Zhu¹, David J Hunter^{1

9}, Jia Li¹⁰, Changhai Ding^{1

11}

Affiliations

¹ Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
² Department of Spinal Surgery, The Fourth Hospital of Changsha, Changsha Hospital of Hunan Normal University, Changsha, Hunan, China.
³ Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
⁴ Department of Nephrology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
⁵ Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
⁶ Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China.
⁷ Department of Orthopedics, The First Affiliated Hospital, Shaoyang University, Shaoyang, Hunan, China.
⁸ Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
⁹ Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia.
¹⁰ Division of Orthopaedic Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
¹¹ Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.

Abstract

Background: Though anterior cruciate ligament (ACL) tear has been widely accepted as an important accelerator for knee osteoarthritis (KOA), the role of intrinsic ACL degeneration in developing KOA has not been fully investigated.

Purpose: To determine whether ACL degeneration, in the absence of ACL tear, is associated with incident KOA over 4 years.

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

Methods: Participants' knees in this nested case-control study were selected from the Osteoarthritis Initiative (OAI) study, with Kellgren-Lawrence grading (Kellgren-Lawrence grading) of 0 or 1 at baseline (BL). Case knees which had incident KOA (KLG ≥2) over 4 years, were matched 1:1 with control knees by gender, age and radiographic status. ACL signal intensity alteration (0-3 scale) and volume were assessed as compositional feature and morphology of ACL degeneration, using knee MRI at P0 (time of onset of incident KOA), P-1 (1 year prior to P0) and baseline. Conditional logistic regression was applied to analyze the association between measures of ACL degeneration and incident KOA.

Results: 337 case knees with incident KOA were matched to 337 control knees. Participants were mostly female (68.5%), with an average age of 59.9 years old. ACL signal intensity alterations at BL, P-1 and P0 were significantly associated with an increased odds of incident KOA respectively (all P for trend ≤0.001). In contrast, ACL volumes were not significantly associated with incident KOA at any time points.

Conclusions: ACL signal intensity alteration is associated with increased incident KOA over 4 years, whereas ACL volume is not.The translational potential of this article: This paper focused on ACL signal intensity alteration which could better reflect ACL degeneration rather than ACL tear during the progression of KOA and explored this topic in a nested case-control study. Utilizing MR images from KOA participants, we extracted the imaging features of ACL. In addition, we established a semi-quantitative score for ACL signal intensity alteration and found a significant correlation between it and KOA incidence. Our findings confirmed that the more severe the ACL signal intensity alteration, the stronger relationship with the occurrence of KOA. This suggests that more emphasis should be placed on ACL degeneration rather than ACL integrity in the future.

Keywords: Anterior cruciate ligament; Degeneration; Knee osteoarthritis; MRI.