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Title: Using biomechanics and MRi changes in Anterior Cruciate Ligament injured subjects to consider the implications for the development of knee osteoarthritis
Author: Rimmer, Paul A.
ISNI:       0000 0004 5351 4566
Awarding Body: Cardiff University
Current Institution: Cardiff University
Date of Award: 2015
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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.
Supervisor: van Deursen, Robert; Sparkes, Valerie Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: QP Physiology ; RD Surgery