TY - JOUR
T1 - The Proximal Tibia Loses Bone Mineral Density After Anterior Cruciate Ligament Injury
T2 - Measurement Technique and Validation of a Quantitative Computed Tomography Method
AU - Marigi, Erick M.
AU - Holmes, David R.
AU - Murthy, Naveen
AU - Levy, Bruce A.
AU - Stuart, Michael J.
AU - Dahm, Diane L.
AU - Rhee, Peter C.
AU - Krych, Aaron J.
N1 - Funding Information:
The authors report the following potential conflicts of interest or sources of funding: E.M.M. reports nonfinancial support from Orthofix Medical, outside the submitted work. B.A.L reports personal fees from Arthrex, IP royalties, paid consultant, and grants from Biomet: research support, other from Clinical Orthopaedics and Related Research: editorial or governing board, other from Journal of Knee Surgery; editorial or governing board, other from Knee Surgery, Sports Traumatology, Arthroscopy; editorial or governing board, other from Orthopedics Today; editorial or governing board, grants, and personal fees from Smith & Nephew; paid consultant, research support, and grants from Stryker; research support and personal fees from Linvatec; and faculty/speaker and personal fees from COVR Medical LLC, outside the submitted work. M.J.S. reports other from Arthrex, during the conduct of the study; other from American Journal of Sports Medicine, grants and personal fees from Arthrex, and grants from Stryker, outside the submitted work. P.C.R. reports nonfinancial support from American Association for Hand Surgery, nonfinancial support from American Society for Surgery of the Hand, nonfinancial support from Clinical Orthopaedic Society, and personal fees from Trimed, outside the submitted work. D.L.D. reports other from the AJSM Medical Publishing Board of Trustees, from American Orthopaedic Society for Sports Medicine, grants from Arthrex, other from the NBA/GE Strategic Advisory Board, personal fees from Tenex Health, personal fees from Sonex Health, LLC, and nonfinancial support from GE Healthcare, outside the submitted work. A.J.K. reports other from Arthrex, during the conduct of the study; grants from Aesculap/B. Braun; other from American Journal of Sports Medicine; personal fees and other from Arthrex; grants from the Arthritis Foundation; grants from Ceterix; grants from Histogenics; other from International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and Minnesota Orthopedic Society; personal fees and other from the Musculoskeletal Transplant Foundation; personal fees from Vericel, DePuy, and JRF; grants from Exactech and Gemini Medical, and personal fees from Responsive Arthroscopy and Joint Restoration Foundation, outside the submitted work. The authors would like to acknowledge the support from the National Institutes of Health (NIH) (R01AR055563). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Funding Information:
The authors report the following potential conflicts of interest or sources of funding: E.M.M. reports nonfinancial support from Orthofix Medical, outside the submitted work. B.A.L reports personal fees from Arthrex, IP royalties, paid consultant, and grants from Biomet: research support, other from Clinical Orthopaedics and Related Research: editorial or governing board, other from Journal of Knee Surgery; editorial or governing board, other from Knee Surgery, Sports Traumatology, Arthroscopy; editorial or governing board, other from Orthopedics Today; editorial or governing board, grants, and personal fees from Smith & Nephew; paid consultant, research support, and grants from Stryker; research support and personal fees from Linvatec; and faculty/speaker and personal fees from COVR Medical LLC, outside the submitted work. M.J.S. reports other from Arthrex, during the conduct of the study; other from American Journal of Sports Medicine, grants and personal fees from Arthrex, and grants from Stryker, outside the submitted work. P.C.R. reports nonfinancial support from American Association for Hand Surgery, nonfinancial support from American Society for Surgery of the Hand, nonfinancial support from Clinical Orthopaedic Society, and personal fees from Trimed, outside the submitted work. D.L.D. reports other from the AJSM Medical Publishing Board of Trustees, from American Orthopaedic Society for Sports Medicine , grants from Arthrex, other from the NBA/GE Strategic Advisory Board, personal fees from Tenex Health, personal fees from Sonex Health, LLC, and nonfinancial support from GE Healthcare, outside the submitted work. A.J.K. reports other from Arthrex, during the conduct of the study; grants from Aesculap/B. Braun; other from American Journal of Sports Medicine; personal fees and other from Arthrex; grants from the Arthritis Foundation; grants from Ceterix; grants from Histogenics; other from International Cartilage Repair Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and Minnesota Orthopedic Society; personal fees and other from the Musculoskeletal Transplant Foundation; personal fees from Vericel, DePuy, and JRF; grants from Exactech and Gemini Medical, and personal fees from Responsive Arthroscopy and Joint Restoration Foundation, outside the submitted work. The authors would like to acknowledge the support from the National Institutes of Health (NIH) ( R01AR055563 ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. Full ICMJE author disclosure forms are available for this article online, as supplementary material .
Publisher Copyright:
© 2021 The Authors
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: To develop a standardized method for tibial tunnel volumetric bone mineral density (BMD) analysis with quantitative computed tomography (qCT) using cadaveric specimens to provide validation of this technique on a healthy control population and to determine whether osteopenia occurs following an anterior cruciate ligament (ACL) injury. Methods: qCT was used to develop a volumetric BMD (mg/cm3) measurement technique throughout the region of a standard tibial tunnel. This method was applied to 90 lower extremities, including 10 matched cadaveric knees, 10 matched healthy knees, 25 ACL-injured knees, and 25 contralateral ACL-uninjured knees. The mean total and segmental (proximal, middle, and distal) tibial tunnel BMD were analyzed. Results: The mean entire tibial tunnel BMD measured 165.8 ± 30.5 mg/cm3 (cadaver), 255.9 ± 28.2 mg/cm3 (healthy control), 290.3 ± 36.4 mg/cm3 (ACL-injured), and 300.1 ± 35.1 (ACL-uninjured). Segmental tibial tunnel BMD demonstrated distal one-third segments as the greatest areas of BMD, followed by proximal one-third, and middle one-third for all cohorts with all pairwise comparisons (P <.001). The mean BMD was significantly greater in the uninjured extremity compared with the injured extremity in the entire tunnel (290.3 vs 300.1; P <.001), proximal (271.2 vs 279.1; P =.002), middle (167.6 vs 179.6; P <.001), and distal segments (432.7 vs 441.7; P =.004) at an average of 8 weeks following ACL injury. Conclusions: A standardized method to quantitatively measure the volumetric BMD within the region of a standard tibial tunnel for ACL reconstruction was successfully developed and validated. Significant osteopenia of the injured knee occurs following ACL injury when compared with the contralateral uninjured knee. This observation has potential clinical implications for ACL graft tibial fixation and healing. Level of Evidence: Descriptive diagnostic study, Level III.
AB - Purpose: To develop a standardized method for tibial tunnel volumetric bone mineral density (BMD) analysis with quantitative computed tomography (qCT) using cadaveric specimens to provide validation of this technique on a healthy control population and to determine whether osteopenia occurs following an anterior cruciate ligament (ACL) injury. Methods: qCT was used to develop a volumetric BMD (mg/cm3) measurement technique throughout the region of a standard tibial tunnel. This method was applied to 90 lower extremities, including 10 matched cadaveric knees, 10 matched healthy knees, 25 ACL-injured knees, and 25 contralateral ACL-uninjured knees. The mean total and segmental (proximal, middle, and distal) tibial tunnel BMD were analyzed. Results: The mean entire tibial tunnel BMD measured 165.8 ± 30.5 mg/cm3 (cadaver), 255.9 ± 28.2 mg/cm3 (healthy control), 290.3 ± 36.4 mg/cm3 (ACL-injured), and 300.1 ± 35.1 (ACL-uninjured). Segmental tibial tunnel BMD demonstrated distal one-third segments as the greatest areas of BMD, followed by proximal one-third, and middle one-third for all cohorts with all pairwise comparisons (P <.001). The mean BMD was significantly greater in the uninjured extremity compared with the injured extremity in the entire tunnel (290.3 vs 300.1; P <.001), proximal (271.2 vs 279.1; P =.002), middle (167.6 vs 179.6; P <.001), and distal segments (432.7 vs 441.7; P =.004) at an average of 8 weeks following ACL injury. Conclusions: A standardized method to quantitatively measure the volumetric BMD within the region of a standard tibial tunnel for ACL reconstruction was successfully developed and validated. Significant osteopenia of the injured knee occurs following ACL injury when compared with the contralateral uninjured knee. This observation has potential clinical implications for ACL graft tibial fixation and healing. Level of Evidence: Descriptive diagnostic study, Level III.
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U2 - 10.1016/j.asmr.2021.09.010
DO - 10.1016/j.asmr.2021.09.010
M3 - Article
AN - SCOPUS:85118551715
SN - 2666-061X
VL - 3
SP - e1921-e1930
JO - Arthroscopy, Sports Medicine, and Rehabilitation
JF - Arthroscopy, Sports Medicine, and Rehabilitation
IS - 6
ER -