ArticleOrthopaedic journal of sports medicine2026
Alteration of Subchondral Bone Density Distribution Across the Knee Joint Before and After Anterior Cruciate Ligament Reconstruction.
Article in Orthopaedic journal of sports medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Anterior cruciate ligament (ACL) injury alters knee kinematics and contact mechanics, increasing posteromedial (PM) loading and the risk of knee osteoarthritis. Because subchondral bone density reflects long-term joint stress, its distribution may indicate chronic loading changes. Previous studies have shown higher proportions of high-density area (HDA%) in the PM tibial subchondral bone of ACL-injured knees than in healthy ones. However, it remains unclear whether ACL reconstruction restores normal tibial subchondral bone density distribution. Purpose/Hypothesis: The purpose of this study was to evaluate changes in tibial subchondral bone density after ACL reconstruction. It was hypothesized that reconstruction would reduce the elevated PM HDA% observed after injury. Study Design: Case series; Level of evidence, 4. Methods: Seventeen patients (7 men, 10 women) who underwent unilateral double-bundle ACL reconstruction were included. Computed tomography-osteoabsorptiometry (CT-OAM) was used to quantify the proportion of the proximal tibial surface occupied by HDA (top 20% of Hounsfield units) within 6 sagittal subregions: anteromedial (AM), centromedial (CM), PM, anterolateral, centrolateral, and posterolateral. The medial ratio represented the percentage of total tibial HDA in the medial compartment. Clinical assessments included side-to-side laxity, pivot-shift test, International Knee Documentation Committee score, Lysholm score, and Knee injury and Osteoarthritis Outcome Score (KOOS). Results: Anterior laxity improved from a mean of 3.3 mm (95% CI, 2.5 to 4.0 mm) to 0.4 mm (95% CI, -0.8 to 1.6 mm) postoperatively, and all pivot-shift tests were negative ( Conclusion: ACL reconstruction reduces PM overloading by decreasing PM HDA%, but the increased medial ratio suggests a shift of loading toward the medial compartment, which may relate to poorer sport-specific function.
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