Quantitative analysis of T2 relaxation times of the patellofemoral joint cartilage 3 years after anterior cruciate ligament reconstruction

Objective: To evaluate patient-specific patellofemoral joint (PFJ) cartilage 3 years postoperatively using T2 mapping magnetic resonance imaging and the uninjured contralateral side as control. Hypothesis: The cartilage of the PFJ in the anterior cruciate ligament (ACL) reconstructed knees would show increased T2 values compared to the uninjured contralateral knees at 3-year follow-up, and the femoral (trochlear) cartilage would be more susceptible than the patella in degeneration in ACL-reconstructed knees. Methods: Ten patients with clinically successful ACL-reconstructed knees were prospectively enrolled 3 years postoperatively. Sagittal images of both knees were obtained using T2 mapping. Cartilage over the medial, central, and lateral regions of the trochlea and patella was divided into superficial and deep regions. Average T2 values of the cartilage at each region of interest of the ACL-reconstructed and uninjured contralateral knees were compared for each individual patient. Results: Overall, the T2 values at the superficial layers of the medial and central trochlear cartilage of the ACL-reconstructed knees were significantly higher than those of the uninjured contralateral knees by 4.23 ± 9.09 milliseconds (8.9%; p = 0.043) and 5.94 ± 8.12 milliseconds (10.9%; p = 0.019), respectively. No significant difference was found in other cartilage areas of the trochlea and patella. In individual patient analysis, increased T2 values of ACL-reconstructed knees were found in all 10 patients in at least one superficial region and eight patients in at least one deep region of the trochlear cartilage, five patients in at least one superficial region, and eight patients in at least one deep region of the patellar cartilage. Conclusion: Despite a clinically satisfactory ACL reconstruction (with negative anteroposterior drawer and pivot shift tests), all patients showed at least one region with increased T2 value of the PFJ cartilage 3 years after ACL reconstruction, especially at the medial compartment of the trochlear cartilage. The Translational Potential of this Article: Little data has been reported on PFJ cartilage condition after ACL reconstruction. This study could help develop noninvasive diagnostic methods for detection of early PFJ cartilage degeneration after ACL reconstruction