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Relationships between tibiofemoral contact forces and cartilage morphology at 2 to 3 years after single-bundle hamstring anterior cruciate ligament reconstruction and in healthy knees

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posted on 2023-04-14, 00:55 authored by David John Saxby, Adam L Bryant, Xinyang Wang, Luca Modenese, Pauline Gerus, Jason M Konrath, Kim L Bennell, Karine Fortin, Tim Wrigley, Flavia M Cicuttini, Christopher J Vertullo, Julian FellerJulian Feller, Tim Whitehead, Price Gallie, David G Lloyd
Background: Prevention of knee osteoarthritis (OA) following anterior cruciate ligament (ACL) rupture and reconstruction is vital. Risk of postreconstruction knee OA is markedly increased by concurrent meniscal injury. It is unclear whether reconstruction results in normal relationships between tibiofemoral contact forces and cartilage morphology and whether meniscal injury modulates these relationships. Hypotheses: Since patients with isolated reconstructions (ie, without meniscal injury) are at lower risk for knee OA, we predicted that relationships between tibiofemoral contact forces and cartilage morphology would be similar to those of normal, healthy knees 2 to 3 years postreconstruction. In knees with meniscal injuries, these relationships would be similar to those reported in patients with knee OA, reflecting early degenerative changes. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three groups were examined: (1) 62 patients who received single-bundle hamstring reconstruction with an intact, uninjured meniscus (mean age, 29.8 ± 6.4 years; mean weight, 74.9 ± 13.3 kg); (2) 38 patients with similar reconstruction with additional meniscal injury (ie, tear, repair) or partial resection (mean age, 30.6 ± 6.6 years; mean weight, 83.3 ± 14.3 kg); and (3) 30 ligament-normal, healthy individuals (mean age, 28.3 ± 5.2 years; mean weight, 74.9 ± 14.9 kg) serving as controls. All patients underwent magnetic resonance imaging to measure the medial and lateral tibial articular cartilage morphology (volumes and thicknesses). An electromyography-driven neuromusculoskeletal model determined medial and lateral tibiofemoral contact forces during walking. General linear models were used to assess relationships between tibiofemoral contact forces and cartilage morphology. Results: In control knees, cartilage was thicker compared with that of isolated and meniscal-injured ACL-reconstructed knees, while greater contact forces were related to both greater tibial cartilage volumes (medial: R2 = 0.43, β = 0.62, P =.000; lateral: R2 = 0.19, β = 0.46, P =.03) and medial thicknesses (R2 = 0.24, β = 0.48, P =.01). In the overall group of ACL-reconstructed knees, greater contact forces were related to greater lateral cartilage volumes (R2 = 0.08, β = 0.28, P =.01). In ACL-reconstructed knees with lateral meniscal injury, greater lateral contact forces were related to greater lateral cartilage volumes (R2 = 0.41, β = 0.64, P =.001) and thicknesses (R2 = 0.20, β = 0.46, P =.04). Conclusion: At 2 to 3 years postsurgery, ACL-reconstructed knees had thinner cartilage compared with healthy knees, and there were no positive relationships between medial contact forces and cartilage morphology. In lateral meniscal-injured reconstructed knees, greater contact forces were related to greater lateral cartilage volumes and thicknesses, although it was unclear whether this was an adaptive response or associated with degeneration. Future clinical studies may seek to establish whether cartilage morphology can be modified through rehabilitation programs targeting contact forces directly in addition to the current rehabilitation foci of restoring passive and dynamic knee range of motion, knee strength, and functional performance.


One or more of the authors has declared the following potential conflict of interest or source of funding: Funding support for this research was received from the Australian National Health and Medical Research Council to A.L.B., D.G.L., K.L.B., and F.M.C. (grant No. 628850), as well as the National Health and Medical Research Council R.D. Wright Biomedical Fellowship and Principal Research Fellowship to authors A.L.B. and K.L.B., respectively. The work of author L.M. was supported by the UK Engineering and Physical Sciences Research Council through grant EP/K03877X/1. D.J.S. received a PhD scholarship and stipend awards from Griffith University, as well as a PhD matching dissertation grant from the International Society of Biomechanics. T.W. is a lecturer for Smith & Nephew and Arthrex, receives research support from Smith & Nephew, and is a consultant for Medacta. C.J.V. receives funding from Smith & Nephew.


Publication Date



Orthopaedic Journal of Sports Medicine





Article Number



13p. (p. 1-13)





Rights Statement

© The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 License ( which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (

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