Abnormal Biomechanics at 6 Months Are Associated With Cartilage Degeneration at 3 Years After Anterior Cruciate Ligament Reconstruction

Purpose: To investigate the changes in landing biomechanics over a 3-year period and their correlation with cartilage degenerative changes in the medial tibiofemoral joint of the knee after anterior cruciate ligament reconstruction (ACLR) using magnetic resonance T1ρ mapping. Methods: Thirty-one anterior cruciate ligament–injured patients underwent magnetic resonance imaging of the injured knee before ACLR and 3 years after ACLR, as well as biomechanical analysis of a drop-landing task at 6 months and 3 years after ACLR. Sixteen healthy individuals were recruited and underwent knee magnetic resonance imaging and biomechanical assessment during a drop-landing task. T1ρ cartilage relaxation times were calculated for the medial femur and tibia. Results: ACLR patients exhibited increased peak vertical ground reaction force (VGRF), VGRF impulse, peak knee flexion moment (KFM), and KFM impulse from 6 months to 3 years (P <.001 for each). Although the ACLR knees showed significantly lower peak VGRF and KFM at 6 months (P <.001 for both) when compared with the controls, there were no significant differences at 3 years. At 3 years, ACLR patients showed higher T1ρ values over the medial femur (P <.001) and tibia (P =.012) when compared with their preoperative values and with healthy control values. Within the ACLR group, side-to-side differences in peak VGRF and sagittal knee biomechanics at 6 months were associated with increased T1ρ values from baseline to 3 years. Conclusions: The results of this longitudinal study show that landing biomechanics are altered after ACLR but biomechanical abnormalities tend to recover at 3 years after ACLR. Differences in lower-extremity mechanics during a landing task at 6 months may be associated with cartilage degeneration at 3 years after anterior cruciate ligament injury and reconstruction. Level of Evidence: Level II, prospective trial.