Concepts Important to Secondary Prevention of Posttraumatic Osteoarthritis

Abstract

oint injuries occur when primary prevention fails or the joint is subjected to overwhelming forces. Although the incidence of noncontact anterior cruciate ligament (ACL) injuries can likely be reduced, ACL tears will continue to occur due to accidents, contact sports, falls, and any number of unpredictable situations resulting in knee trauma. Thus, a substantial role remains for improving patients' surgical and rehabilitative outcomes in the aftermath of ACL tears. To achieve these goals, validated and appropriate outcome measures are key to evaluating and optimizing current treatment protocols and developing new strategies to prevent poor outcomes, including posttraumatic osteoarthritis (PTOA). Understanding the concept of pre-osteoarthritis (pre-OA) is important for optimizing protocols for rehabilitating patients with ACL injury. 1,2 In the early years after joint injury, most patients do not have signs or symptoms of clinical osteoarthritis (OA). However, measurable changes to the joint that persist and progress in a large proportion of patients are observable after injury and reconstructive surgery. 3-14 Developing and validating new techniques to measure potentially reversible and clinically occult joint changes reflective of OA risk are critical to identifying pre-OA. Pre-osteoarthritis has been defined as ''conditions where clinical OA has not yet developed; rather, joint homeostasis has been compromised and there are potentially reversible markers for heightened OA risk.'' 1 The existence of pre-OA after ACL injury can be demonstrated using a systemsbased approach to assess the OA risk by evaluating the interactions among structural, biological, and mechanical factors in patients during the first 2 years after ACL reconstruction (ACLR). Evidence for subclinical cartilage damage after ACL injury has been shown using compositional magnetic resonance imaging (MRI) techniques, such as T2 mapping, 5 T1rho, 6 dGEMRIC, 7 and the newer MRI ultrashort echo time (UTE) enhanced T2* mapping. 8 The UTE designation refers to the incorporation of image data using research software (instead of conventional MRI) to acquire echo times of less than 1 millisecond. Acutely, after ACL injury, novel compositional MRI UTE enhanced T2* mapping 9-11 showed elevated values for menisci and cartilage that appeared normal on conventional MRI. 9,11 Two years after anatomic ACLR, these values were no longer different from those of uninjured control participants, 9 which demonstrates the potential reversibility of the observed changes and is suggestive of

The efficacy of anterior cruciate ligament reconstruction and rehabilitation compared to conservative management for reducing the incidence of post-traumatic osteoarthritis following anterior cruciate ligament injury: A systematic review

“…Therefore, our synthesis of the available studies indicates limited evidence of a difference between ACLR and rehabilitation compared to conservative management on the incidence of PTOA after ACL injury. Research indicates surgery may provide benefits by improving joint stability and reducing the risk of a secondary injury such as meniscal tears (Chu, 2019). There is also conflicting evidence that surgery may exacerbate and prolong the intraarticular inflammatory response, subsequently increasing the risk of PTOA (Thomas et al, 2017).…”

Chronic post-traumatic pain: rheumatological and orthopedic aspects

“…Профилактика ХПТБ заключается в эффективном купировании острой боли, подавлении локального воспаления и замедлении развития дегенеративных процессов [90].…”

Anterior Cruciate Ligament Research Retreat VIII Summary Statement: An Update on Injury Risk Identification and Prevention Across the Anterior Cruciate Ligament Injury Continuum, March 14–16, 2019, Greensboro, NC

“…8 Quantitative magnetic resonance imaging (MRI) relaxation mapping has been primarily validated for articular cartilage tissue. [62][63][64] In addition to the research presented at ACL Research Retreat VIII, including the use of novel MRI ultrashort echo time T2* to evaluate healing ACL grafts, 21,65 T2* relaxation has been used to study animal ACL grafts 66,67 and has been negatively associated with the yield load of healing ACL grafts. 66 Additionally, these imaging sequences have been used to evaluate the structural characteristics of the Achilles 68 and patellar 69 tendons.…”

“…Mounting evidence suggests that the progression to PTOA is influenced by the interplay between aberrant joint biomechanics and altered joint tissue metabolism after injury. 126,[159][160][161][162] Work reflecting more than a decade of longitudinal study 21,163 of ACL-injured patients at the University of Pittsburgh and Stanford University presented by keynote speaker Constance Chu, MD, showed that approximately half of patients had quantitative MRI ultrashort echo time-T2*, mechanical, or biological markers indicating a higher OA risk just 2 years after ACLR. Several researchers sought to characterize the effects of early structural, biomechanical, and biological changes after ACL injury and their association with important outcomes related to joint health status over time (Blackburn abstract #29, Pfeiffer abstract #30, Wallace abstract #31, and Trump abstract #32).…”

“…The summary of these discussions follows. We also present the summaries 21,22 of 2 keynotes and the research abstracts 23 on which these discussions were based. (Note: As Dr DeFrate's keynote focused primarily on recently completed yet unpublished data, a written summary is not included.…”