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Using biomechanics and MRi changes in Anterior Cruciate Ligament injured subjects to consider the implications for the development of knee osteoarthritis

Rimmer, Paul A. 2015. Using biomechanics and MRi changes in Anterior Cruciate Ligament injured subjects to consider the implications for the development of knee osteoarthritis. PhD Thesis, Cardiff University.
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Background: The present study aimed to explore if risk factors associated with loading at knee were associated with degenerative changes in ACL injured groups. Methods: Part 1: Biomechanics were investigated for gait, jogging and single legged squatting (SLS) in Anterior Crucitate Ligament Reconstructed (ACLR) (n=30), Anterior Cruciate Ligament Deficient (ACLD) (n=28) and controls (n=30). Analysis of biomechanics was also undertaken on a subgroup of ACLR (ACLR2) (n=10) 12.9±1.8 months after their first assessment. From the ACLR2 those with MRi (ACLM) were recruited (n=8). Part 2: Comparison between the ACLM groups NHS diagnostic scans and a follow up scan was undertaken 27±11.7 months apart. Quantitative measurement of cartilage thickness and a semi-quantitative analysis developed from the Whole-Organ Magnetic Resonance Imaging Score (WORMS) was undertaken. Part 3: Used a case series analysis incorporating individual participants’ outcomes from the first two parts of the study. Statistical analysis: Differences between ACLR, ACLD and control groups was performed using ANOVA. Longitudinal analysis was performed using a paired t-test and changes in MRi using a Wilcoxen signed-rank test. Results: Biomechanics: No significant differences between groups existed for gait. For jogging ACLD and ACLR demonstrated reductions in peak knee extensor moment. The SLS showed a reduction in sagittal plane knee range of motion in the ACLD. The ACLD group had lower self-reported measures of function compared to the ACLR group. Quantitative MRi: No significant differences in regional cartilage thickness between diagnostic and follow up scans was observed. Semi-quantitative MRi: Significant improvement in total knee score was observed in ACLM. Discussion: Despite increased loading being associated with the development of OA, the ACLD and ACLR groups maintained or decreased knee moments. Interestingly, the one ACLM participant with worsening of total semi-quantitative score had evidence of decreased extensor moment. However, reductions in net moment caused by a stiffening strategy may still lead to increased compression forces that may have implications for knee health in the full ACLR and ACLD. Conclusion: No evidence of degenerative changes was found in ACLM. However, individual’s demonstrated degenerative changes in some features; this may suggest that OA is an end point but initiated and developed through different mechanisms.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Healthcare Sciences
Subjects: Q Science > QP Physiology
R Medicine > RD Surgery
Funders: Arthritis Research UK
Date of First Compliant Deposit: 30 March 2016
Last Modified: 07 Mar 2022 16:42

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