目的:软骨和半月板是维持膝关节健康的重要结构。在发生形态学变化之前,早期检测软骨和半月板内部成分的变化对于预防和延迟骨关节炎(OA)的发展至关重要。本研究旨在确定前交叉韧带(ACL)断裂急性期形态完整的软骨和半月板的基质组成变化,以及急性期半月板不同状态(完整或撕裂)对相邻软骨的影响。
方法:这项横断面研究比较并分析了50例ACL断裂急性期患者,这些患者接受了手术治疗,年龄66岁,从2022年5月到2023年5月在我们机构的体重和身高匹配的健康志愿者。使用Mann-Whitney非参数t检验比较两组胫骨股关节软骨和半月板不同区域的平均T2弛豫时间和效应大小,分析不同半月板状态与相邻软骨的相关性。
结果:在膝关节的外侧和内侧,ACL破裂组的软骨和半月板的所有亚区的T2弛豫时间均明显高于(p<0.05),损伤部位主要集中在内侧隔室(股骨,p=0.000;胫骨,p=0.000;前角,p=0.000)。在各自的隔间中,外侧半月板后角与股骨和胫骨中部软骨呈显著正相关(r=0.566,p=0.035;r=0.611,p=0.02);内侧半月板后角与胫骨后部软骨呈显著正相关(r=0.668,p=0.018)。
结论:在ACL破裂的急性期,软骨和半月板的内部成分发生了重大变化,即使形态完好无损。更重要的是,半月板的状态显着影响相邻软骨的内部组成。这是OA的预警信号,在临床实践中应密切监测和小心管理。
OBJECTIVE: Cartilage and
meniscus are important structures that maintain the health of the knee joint. Early detection of changes in the internal components of cartilage and
meniscus before morphological changes occur is essential to prevent and delay the development of osteoarthritis (OA). This study was designed to determine the changes in the matrix composition of morphologically intact cartilage and
meniscus during the acute phase of an anterior cruciate ligament (ACL) rupture, as well as the effect of different states of
meniscus (intact or tear) on adjacent cartilage during the acute phase.
METHODS: This cross-sectional study compared and analyzed 50 patients in the acute phase of ACL rupture who underwent surgical treatment and 66 age-, weight- and height-matched healthy volunteers from May 2022 to May 2023 at our institution. Mean T2 relaxation times and effect sizes in different regions of tibiofemoral articular cartilage and meniscus were compared between the two groups using the Mann-Whitney nonparametric t-test, and correlations between different meniscal states and adjacent cartilage were analyzed.
RESULTS: Both in the lateral and medial compartments of the knee, T2 relaxation times were significantly higher in all subregions of cartilage and meniscus in the ACL rupture group (p < 0.05), and the site of injury was predominantly centered in the medial compartment (femur, p = 0.000; tibia, p = 0.000; anterior horn, p = 0.000). In the respective compartments, the posterior horn of the lateral
meniscus showed a significant positive correlation with the mid-cartilage of the femoral and tibial (r = 0.566, p = 0.035; r = 0.611, p = 0.02); and the posterior horn of the medial meniscus showed a significant positive correlation with the posterior tibial cartilage (r = 0.668, p = 0.018).
CONCLUSIONS: During the acute phase of ACL rupture, the internal composition of the cartilage and meniscus undergoes significant changes, even if the morphology is intact. More importantly, the state of the meniscus significantly affects the internal composition of the adjacent cartilage. This is an early warning sign of OA, which should be closely monitored and carefully managed in clinical practice.