Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessment
Abstract Purpose Surgical reconstruction is the current standard for ACL rupture treatment in active individuals. Recently, there is renewed interest in primary repair of proximal ACL tears. Despite this, ACL biology and healing potential are currently not well understood. Vascularity is paramount i...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-01-01
|
| Series: | Journal of Experimental Orthopaedics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40634-022-00486-8 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850225344510951424 |
|---|---|
| author | Kenneth M. Lin Harmen D. Vermeijden Craig E. Klinger Lionel E. Lazaro Scott A. Rodeo Jonathan P. Dyke David L. Helfet Gregory S. DiFelice |
| author_facet | Kenneth M. Lin Harmen D. Vermeijden Craig E. Klinger Lionel E. Lazaro Scott A. Rodeo Jonathan P. Dyke David L. Helfet Gregory S. DiFelice |
| author_sort | Kenneth M. Lin |
| collection | DOAJ |
| description | Abstract Purpose Surgical reconstruction is the current standard for ACL rupture treatment in active individuals. Recently, there is renewed interest in primary repair of proximal ACL tears. Despite this, ACL biology and healing potential are currently not well understood. Vascularity is paramount in ACL healing; however, previous ACL vascularity studies have been limited to qualitative histological and dissection‐based techniques. The study objective was to use contrast‐enhanced quantitative‐MRI to compare relative perfusion of proximal, middle, and distal thirds of the in situ ACL. We hypothesized perfusion would be greatest in the proximal third. Methods Fourteen cadaveric knees were studied (8 females, 6 males), age 25–61 years. Superficial femoral, anterior tibial, and posterior tibial arteries were cannulated; without intraarticular dissection. Contrast‐enhanced quantitative‐MRI was performed using a previously established protocol. ACL regions corresponding to proximal, middle, and distal thirds were identified on sagittal‐oblique pre‐contrast images. Signal enhancement (normalized to tibial plateau cartilage) was quantified to represent regional perfusion as a percentage of total ACL perfusion. Comparative statistics were computed using repeated measures ANOVA, and pairwise comparisons performed using the Bonferroni method. Results Relative perfusion to proximal, middle, and distal ACL zones were 56.0% ±17.4%, 28.2% ±14.6%, and 15.8% ±16.3%, respectively (p = 0.002). Relative perfusion to the proximal third was significantly greater than middle (p = 0.007) and distal (p = 0.001). No statistically relevant difference in relative perfusion was found to middle and distal thirds (p = 0.281). Post‐hoc subgroup analysis demonstrated greater proximal perfusion in males (66.9% ± 17.3%) than females (47.8% ± 13.0%), p = 0.036. Conclusion Using quantitative‐MRI, in situ adult ACL demonstrated greatest relative perfusion to the proximal third, nearly 2 times greater than the middle third and 3 times greater than the distal third. Knowledge of differential ACL vascular supply is important for understanding pathogenesis of ACL injury and the process of biological healing following various forms of surgical treatment. |
| format | Article |
| id | doaj-art-16e6c77ae8214f31b1b25ca9bef93d14 |
| institution | OA Journals |
| issn | 2197-1153 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-16e6c77ae8214f31b1b25ca9bef93d142025-08-20T02:05:23ZengWileyJournal of Experimental Orthopaedics2197-11532022-01-0191n/an/a10.1186/s40634-022-00486-8Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessmentKenneth M. Lin0Harmen D. Vermeijden1Craig E. Klinger2Lionel E. Lazaro3Scott A. Rodeo4Jonathan P. Dyke5David L. Helfet6Gregory S. DiFelice7Department of Orthopaedic SurgeryHospital for Special Surgery535 East 70th Street10021New YorkNYUSADepartment of Orthopaedic SurgeryHospital for Special Surgery535 East 70th Street10021New YorkNYUSADepartment of Orthopaedic SurgeryHospital for Special Surgery535 East 70th Street10021New YorkNYUSAMiami Orthopedics and Sports Medicine InstituteBaptist Health South FloridaMiamiFLUSADepartment of Orthopaedic SurgeryHospital for Special Surgery535 East 70th Street10021New YorkNYUSACitigroup Biomedical Imaging Center and Weill Cornell MedicineNew YorkNYUSADepartment of Orthopaedic SurgeryHospital for Special Surgery535 East 70th Street10021New YorkNYUSADepartment of Orthopaedic SurgeryHospital for Special Surgery535 East 70th Street10021New YorkNYUSAAbstract Purpose Surgical reconstruction is the current standard for ACL rupture treatment in active individuals. Recently, there is renewed interest in primary repair of proximal ACL tears. Despite this, ACL biology and healing potential are currently not well understood. Vascularity is paramount in ACL healing; however, previous ACL vascularity studies have been limited to qualitative histological and dissection‐based techniques. The study objective was to use contrast‐enhanced quantitative‐MRI to compare relative perfusion of proximal, middle, and distal thirds of the in situ ACL. We hypothesized perfusion would be greatest in the proximal third. Methods Fourteen cadaveric knees were studied (8 females, 6 males), age 25–61 years. Superficial femoral, anterior tibial, and posterior tibial arteries were cannulated; without intraarticular dissection. Contrast‐enhanced quantitative‐MRI was performed using a previously established protocol. ACL regions corresponding to proximal, middle, and distal thirds were identified on sagittal‐oblique pre‐contrast images. Signal enhancement (normalized to tibial plateau cartilage) was quantified to represent regional perfusion as a percentage of total ACL perfusion. Comparative statistics were computed using repeated measures ANOVA, and pairwise comparisons performed using the Bonferroni method. Results Relative perfusion to proximal, middle, and distal ACL zones were 56.0% ±17.4%, 28.2% ±14.6%, and 15.8% ±16.3%, respectively (p = 0.002). Relative perfusion to the proximal third was significantly greater than middle (p = 0.007) and distal (p = 0.001). No statistically relevant difference in relative perfusion was found to middle and distal thirds (p = 0.281). Post‐hoc subgroup analysis demonstrated greater proximal perfusion in males (66.9% ± 17.3%) than females (47.8% ± 13.0%), p = 0.036. Conclusion Using quantitative‐MRI, in situ adult ACL demonstrated greatest relative perfusion to the proximal third, nearly 2 times greater than the middle third and 3 times greater than the distal third. Knowledge of differential ACL vascular supply is important for understanding pathogenesis of ACL injury and the process of biological healing following various forms of surgical treatment.https://doi.org/10.1186/s40634-022-00486-8ACL vascularityPerfusionQuantitative MRIACL primary repairACL reconstructionRemnant preservation |
| spellingShingle | Kenneth M. Lin Harmen D. Vermeijden Craig E. Klinger Lionel E. Lazaro Scott A. Rodeo Jonathan P. Dyke David L. Helfet Gregory S. DiFelice Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessment Journal of Experimental Orthopaedics ACL vascularity Perfusion Quantitative MRI ACL primary repair ACL reconstruction Remnant preservation |
| title | Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessment |
| title_full | Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessment |
| title_fullStr | Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessment |
| title_full_unstemmed | Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessment |
| title_short | Differential regional perfusion of the human anterior cruciate ligament: quantitative magnetic resonance imaging assessment |
| title_sort | differential regional perfusion of the human anterior cruciate ligament quantitative magnetic resonance imaging assessment |
| topic | ACL vascularity Perfusion Quantitative MRI ACL primary repair ACL reconstruction Remnant preservation |
| url | https://doi.org/10.1186/s40634-022-00486-8 |
| work_keys_str_mv | AT kennethmlin differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment AT harmendvermeijden differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment AT craigeklinger differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment AT lionelelazaro differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment AT scottarodeo differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment AT jonathanpdyke differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment AT davidlhelfet differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment AT gregorysdifelice differentialregionalperfusionofthehumananteriorcruciateligamentquantitativemagneticresonanceimagingassessment |