Degenerative changes in cartilage likely occur in the medial compartment after anterior cruciate ligament reconstruction

  • Tetsuro Ushio
  • Ken OkazakiEmail author
  • Kanji Osaki
  • Yukihisa Takayama
  • Koji Sagiyama
  • Hideki Mizu-uchi
  • Satoshi Hamai
  • Yukio Akasaki
  • Hiroshi Honda
  • Yasuharu Nakashima



Magnetic resonance imaging with T1ρ mapping is used to quantify the amount of glycosaminoglycan in articular cartilage, which reflects early degenerative changes. The purposes of this study were to evaluate early degenerative changes in knees after anterior cruciate ligament (ACL) reconstruction by comparing T1ρ values before and 2 years after surgery and investigate whether surgical factors and clinical outcomes are related to differences in T1ρ values.


Fifty patients who underwent unilateral primary ACL reconstruction were evaluated using T1ρ mapping before and 2 years after surgery. Three regions of interest (ROIs) were defined in the cartilage associated with the medial (M) and lateral (L) weight-bearing areas of the femoral condyle (FC) (anterior: MFC1 and LFC1, middle: MFC2 and LFC2, and posterior: MFC3 and LFC3). Two ROIs associated with the tibial plateau (T) were defined (anterior: MT1 and LT1, and posterior: MT2 and LT2). T1ρ values within the ROIs were measured before and 2 years after surgery and compared using the paired t test. Correlations between the difference in T1ρ values at these two time points and patient characteristics, presence of a cartilaginous lesion, graft type, and postoperative anteroposterior laxity were also evaluated using Pearson’s and Spearman’s correlation coefficients.


There was a significant increase in T1ρ before versus 2 years after surgery in the MT1, MT2, LFC1, and LT1 areas, and a significant decrease in the LFC3 and LT2 areas. There was a significant correlation between postoperative anterior-posterior laxity and a postoperative increase in T1ρ values in the MFC3 (r = 0.37, P = 0.013) and MT2 (r = 0.35, P = 0.021) areas. Increases in T1ρ values in the MFC2 area were negatively correlated with KOOS symptoms (ρ = − 0.349, P = 0.027) and quality of life (ρ = − 0.374, P = 0.017) subscale scores.


Early degenerative changes in medial articular cartilage were observed with T1ρ mapping at 2 years after ACL reconstruction. Postoperative anterior-posterior laxity is correlated with an increase in T1ρ values in the posteromedial femur and tibia. An increase in T1ρ values in the central medial femoral condyle was associated with knee symptoms.

Level of evidence



Anterior cruciate ligament Degenerative changes Osteoarthritis T1ρ mapping Outcomes 



: Anterior cruciate ligament


: Magnetic resonance imaging


: Region of interest


: Medial femoral condyle


: Lateral femoral condyle


: Medial tibia


: Lateral tibia


: Osteoarthritis


: Delayed gadolinium-enhanced MRI of cartilage


: Body Mass Index


: Femorotibial angle


: Anteroposterior


: Posterior tibial slope


: International Cartilage Repair Society


: Bone-tendon-bone


: Whole-Organ MRI Scoring


: Anterolateral rotational instability


: Knee Injury and Osteoarthritis Outcome Score


: Activity of daily living


: Quality of life



The authors thank Mr. Junji Kishimoto, a statistician from the Digital Medicine Initiative of Kyushu University, for his advice on the statistical analysis.

Author contributions

TU collected and analysed data and drafted the manuscript. KO conceived the study, contributed to its design, collected and analysed data, coordinated the study, and helped to draft the manuscript. KO is also the corresponding author. YT, KS, and HH collected and analysed data. HM, SH, and YA assisted in drafting the manuscript. YN gave final approval to the manuscript.


No financial support was provided to this study.

Compliance with ethical standards

Conflict of interest

KO has received speaker honoraria from Zimmer Biomet and Smith & Nephew. HM has received a speaker honorarium from Zimmer Biomet.

Ethical approval

Ethical approval was provided by the IRB of Kyushu University.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  • Tetsuro Ushio
    • 1
  • Ken Okazaki
    • 2
    Email author
  • Kanji Osaki
    • 1
  • Yukihisa Takayama
    • 3
  • Koji Sagiyama
    • 3
  • Hideki Mizu-uchi
    • 1
  • Satoshi Hamai
    • 1
  • Yukio Akasaki
    • 1
  • Hiroshi Honda
    • 3
  • Yasuharu Nakashima
    • 1
  1. 1.Department of Orthopaedic Surgery, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of Orthopaedic SurgeryTokyo Women’s Medical UniversityTokyoJapan
  3. 3.Department of Clinical Radiology, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan

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