Accelerated return to sport after anterior cruciate ligament injury: a risk factor for early knee osteoarthritis?

Culvenor, Adam G; Crossley, Kay M

doi:10.1136/bjsports-2015-095542

Cited by 17 publications

(11 citation statements)

References 12 publications

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“…7 On the other hand, several relevant studies have described a correlation between postoperative biomechanics and early cartilage degeneration. Culvenor and Crossley 6 reported that patients returning to sports within 10 months of ACLR showed higher rates of MRI-identified bone marrow lesions at 12 months, a possible indicator of impending arthritis development. Teng et al 31 reported that patients with higher vertical ground-reaction forces at 6 months postoperatively had higher T 1 ρ degeneration, indicating that early aggressive physical therapy may be detrimental to long-term cartilage health.…”

Section: Discussionmentioning

confidence: 99%

Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction

Friedman

Zhang

et al. 2021

Am J Sports Med

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Background: The association between activity level after anterior cruciate ligament (ACL) reconstruction (ACLR) and development of posttraumatic osteoarthritis (PTOA) remains unclear. This study investigated the relationship of patient-reported outcomes and progressive cartilage degenerative changes at 3 years after ACLR. Hypothesis: Higher activity levels, as measured by Marx scores, are significantly correlated with early cartilage degeneration after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 35 patients (16 women; mean age, 31.0 ± 7.6 years) with isolated ACLR and without pre-existing arthritis were prospectively enrolled. Patients reported Marx activity scores and Knee injury and Osteoarthritis Outcome Score (KOOS) scores and underwent T1ρ magnetic resonance imaging (MRI) preoperatively, 6 months, 1 year, 2 years, and 3 years after ACLR with soft tissue graft (22 autograft). The change in cartilage relaxation times between preoperative and 3-year imaging was used to identify cartilage degeneration, defined as an increase in T1ρ values by 14.3%. Correlation between Marx activity levels, KOOS scores, and T1ρ degeneration was performed with the Spearman rank test. The Fisher exact test was used to test for association between Marx activity score cutoffs and degeneration. The Student t test was used to compare Whole-Organ Magnetic Resonance Imaging Score (WORMS) and T1ρ relaxation times. Significance was defined as P < .05. Results: Sixteen patients (45.7%) showed evidence of cartilage degeneration at 3 years, most frequently in the medial compartment (n = 12; 34%). Higher Marx activity scores at 3 years correlated with cartilage degeneration in the medial femur (rho = 0.34; P = .045), and medial tibia (rho = 0.43; P = .01). A Marx score of 11 or greater at 3 years was significantly associated with medial compartment degeneration ( P = .03), with a positive predictive value of 52.6%. No Marx score cutoff at years 1 or 2 predicted future cartilage degeneration. The KOOS Quality of Life score was inversely correlated with cartilage degeneration (rho = 0.38; P = .02). WORMS did not correlate with degeneration of the medial compartment. Conclusion: Increased activity at 3 years after ACLR was significantly associated with increased risk of medial compartment PTOA. While further research is needed to fully define these relationships, patients may be counseled that return to Marx activity levels of greater than 11 may be associated with a higher risk of medial compartment cartilage degeneration.

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Section: Discussionmentioning

confidence: 99%

Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction

Friedman

Zhang

et al. 2021

Am J Sports Med

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“…We did not expect to find such consistent relationships between return to sport and QOL outcomes 5–20 years after ACLR in people with knee difficulties. Although return to sport was associated with better QOL, the longer‐term impact of returning to sport with knee difficulties on future joint health should be considered (Culvenor & Crossley, ). The high rate of participants reporting a preference to take part in sport in the absence of knee difficulties, over and above other activities including family or occupational duties, suggests that sport participation remains a priority for many individuals.…”

Section: Discussionmentioning

confidence: 99%

Return to sport matters—longer‐term quality of life after ACL reconstruction in people with knee difficulties

Filbay

Ackerman

Russell

et al. 2016

Scandinavian Med Sci Sports

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Many individuals experience long-term quality of life (QOL) impairment following anterior cruciate ligament reconstruction (ACLR). Factors contributing to poor QOL and psychological health >5 years after ACLR remain unclear. This study aimed to describe QOL and psychological health outcomes in people with knee difficulties (pain, symptoms, or functional limitations) 5-20 years following ACLR and identify factors explaining variability in these outcomes. Participants with knee difficulties 5-20 years following ACLR completed a battery of validated patient-reported outcomes [including the Knee injury and Osteoarthritis Outcome Score (KOOS), ACL-QOL, and the Assessment of QOL (AQoL-8D) instrument]. Multivariable linear regression was used to identify factors explaining variability in outcomes. One hundred sixty-two participants aged 38 ± 9 (mean ± SD) years completed questionnaires 9 ± 4 (range 5-20) years following ACLR. Thirty-nine percent of participants returned to competitive sport, 28% returned to a lower level, and 32% did not return to sport after ACLR. Not returning to sport after ACLR was associated with worse KOOS-QOL (β = 0.29, P = 0.001 [mean ± SD (55 ± 20)], ACL-QOL [β = 0.48, P < 0.001; (57 ± 21)], and AQoL-8D [β = 0.22, P = 0.02 (0.80 ± 0.14)]) scores. Increased body mass index (56% were overweight/obese) was related to worse QOL and more depressive symptoms. Subsequent knee surgery and contralateral ACLR were also associated with poorer QOL outcomes in these individuals.

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“…15 Early return to sport with persistent impairments in muscle strength and lower extremity function may be associated with an increased risk of OA change. 6 In addition, the individuals in the present study were slightly overweight (body mass index, 25.9), possibly because of a protracted time of disability before surgery. As obesity is a well-established extrinsic risk factor for OA 24 and has been linked with dynamic balance in hip pain populations, 11 interventions that address body mass should also be considered before return to sport.…”

Section: Discussionmentioning

confidence: 63%

Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology

et al. 2019

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Background: Hip pain is associated with reduced muscle strength, range of movement (ROM), and function. Hip arthroscopy is undertaken to address coexistent intra-articular pathologies with the aim of reducing pain and improving function. Purpose: To evaluate changes in strength and ROM in a cohort with chondrolabral pathology before surgery to 3 and 6 months after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Sixty-seven individuals with hip pain who were scheduled for hip arthroscopy were matched with 67 healthy controls. Hip strength and ROM were collected preoperatively and at 3 and 6 months postoperatively. Repeated measures analysis of variance evaluated whether strength and ROM differed between limbs and among time points. Bonferroni post hoc tests determined differences in hip strength and ROM among testing times and between the hip pain group and matched controls. Results: Hip extension, internal rotation (IR), external rotation (ER), and adduction ( P < .040) strength were greater at 3 months after surgery; all directions, including flexion, abduction, and squeeze, were greater at 6 months ( P < .015). Hip flexion ROM was greater at 3 months after surgery ( P = .013). Flexion, IR, and ER ROM was greater at 6 months ( P < .041). At 6 months, IR ROM ( P = .003) and flexion, IR, and ER strength ( P < .005) remained less than matched controls. Conclusion: With the exception of squeeze and flexion, all directions of hip strength and hip flexion ROM are significantly improved 3 months after arthroscopy to address chondrolabral pathology. By 6 months after arthroscopy, strength in all directions and flexion and rotation ROM are significantly improved in both limbs, but hip flexion, IR, and ER strength and IR ROM remain significantly less than that of healthy matched controls in both limbs.

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Accelerated return to sport after anterior cruciate ligament injury: a risk factor for early knee osteoarthritis?

Cited by 17 publications

References 12 publications

Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction

Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction

Return to sport matters—longer‐term quality of life after ACL reconstruction in people with knee difficulties

Acute and Subacute Changes in Hip Strength and Range of Movement After Arthroscopy to Address Chondrolabral Pathology

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