Knee MRI biomarkers associated with structural, functional and symptomatic changes at least a year from ACL injury - A systematic review

O’Sullivan, Oliver; Ladlow, Peter; Steiner, Kat; Kuyser, Dahria; Ali, Omaima; Stocks, Joanne; Valdes, Ana M.; Bennett, Alexander N.; Kluzek, Stefan

Abstract

Introduction
Osteoarthritis (OA) results from various aetiologies, including joint morphology, biomechanics, inflammation, and injury. The latter is implicated in post-traumatic OA, which offers a paradigm to identify potential biomarkers enabling early identification and intervention. This review aims to describe imaging features associated with structural changes or symptoms at least one year following injury.

Methodology
A systematic review was conducted using PRISMA guidance, prospectively registered on PROSPERO (CRD42022371838). Three independent reviewers screened titles and abstracts, followed by full-texts, performed data extraction, and risk of bias assessments (Newcastle-Ottawa Scale). Inclusion criteria included imaging studies involving human participants aged 18–45 who had sustained a significant knee injury at least a year previously. A narrative synthesis was performed using synthesis without meta-analysis methodology.

Results
Six electronic databases and conference proceedings were searched, identifying 11 studies involving 776 participants. All studies included participants suffering an anterior cruciate ligament (ACL) injury and utilised MRI. Different, and not directly comparable, techniques were used. MRI features could be broadly divided into structural, including joint position and morphology, and compositional. Promising biomarkers for diagnosing and predicting osteoarthritis include T1rho and T2 relaxation time techniques, bone morphology changes and radiomic modelling.

Discussion
As early as 12 months after injury, differences in tibia position, bone morphology, presence of effusion and synovitis, and cartilage/subchondral bone composition can be detected, some of which are linked with worse patient-reported or radiological progression. Standardisation, including MR strength, position, sequence, scoring and comparators, is required to utilise clinical and research OA imaging biomarkers fully.

Citation

O’Sullivan, O., Ladlow, P., Steiner, K., Kuyser, D., Ali, O., Stocks, J., …Kluzek, S. (2023). Knee MRI biomarkers associated with structural, functional and symptomatic changes at least a year from ACL injury - A systematic review. Osteoarthritis and Cartilage Open, 5(3), Article 100385. https://doi.org/10.1016/j.ocarto.2023.100385

• Journal Article Type: Article
• Acceptance Date: Jul 11, 2023
• Online Publication Date: Jul 28, 2023
• Publication Date: Sep 1, 2023
• Deposit Date: Sep 6, 2023
• Publicly Available Date: Sep 6, 2023
• Journal: Osteoarthritis and Cartilage Open
• Print ISSN: 2665-9131
• Electronic ISSN: 2665-9131
• Publisher: Elsevier BV
• Peer Reviewed: Peer Reviewed
• Volume: 5
• Issue: 3
• Article Number: 100385
• DOI: https://doi.org/10.1016/j.ocarto.2023.100385
• Keywords: Biomarkers; Post-traumatic osteoarthritis; OA; Chronic; MRI
• Public URL: https://nottingham-repository.worktribe.com/output/23220173
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2665913123000523
• Additional Information: This article is maintained by: Elsevier; Article Title: Knee MRI biomarkers associated with structural, functional and symptomatic changes at least a year from ACL injury - A systematic review; Journal Title: Osteoarthritis and Cartilage Open; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.ocarto.2023.100385; Content Type: article; Copyright: Crown Copyright © 2023 Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International (OARSI).