Predictors of Osteoarthritis Development at a Median 25 Years After Anterior Cruciate Ligament Reconstruction Using a Patellar Tendon Autograft

Lindanger, Line; Strand, Torbjørn; Mølster, Anders; Solheim, Eirik; Fischer-Bredenbeck, Cornelia; Ousdal, Olga Therese; Inderhaug, Eivind

doi:10.1177/03635465221079327

Cited by 19 publications

(12 citation statements)

References 51 publications

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“…19 Older age at injury, specifically, has been a well-documented risk factor for osteoarthritis after reconstruction. 12,32,23 Although the median age of the patients in this cohort was 26 years, it is important to note that among patients who developed PTOA, the median age was significantly older, at 35 years. The age difference was further exaggerated (40 vs 26 years) among patients who ultimately underwent TKA.…”

Section: Discussionmentioning

confidence: 93%

Predicting the Risk of Posttraumatic Osteoarthritis After Primary Anterior Cruciate Ligament Reconstruction: A Machine Learning Time-to-Event Analysis

Lu,

Reinholz,

Till

et al. 2023

Am J Sports Med

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Background: There is a significant long-term risk of posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament reconstruction (ACLR). Elucidating the risk factors and successfully identifying at-risk patients is challenging. Purpose/Hypothesis: The purpose of this study was to produce machine learning survival models that can identify (1) patients at risk of symptomatic PTOA and (2) patients who are at risk of undergoing total knee arthroplasty (TKA) after ACLR. It was hypothesized that these models would outperform traditional Kaplan-Meier estimators. Study Design: Case-control study; Level of evidence, 3. Methods: A geographic database was used to identify patients undergoing ACLR between 1990 and 2016 with a minimum 7.5-year follow-up. Models were used to analyze various factors to predict the rate and time to (1) symptomatic osteoarthritis and (2) TKA using random survival forest (RSF) algorithms. Performance was measured using out-of-bag (OOB) c-statistic, calibration, and Brier score. The predictive performances of the RSF models were compared with Kaplan-Meier estimators. Model interpretability was enhanced utilizing global variable importance and partial dependence curves. Results: A total of 974 patients with ACLR and a minimum follow-up of 7.5 years were included; among these, 215 (22.1%) developed symptomatic osteoarthritis, and 25 (2.6%) progressed to TKA. The RSF algorithms achieved acceptable good to excellent predictive performance for symptomatic arthritis (OOB c-statistic, 0.75; Brier score, 0.128) and progression to TKA (OOB c-statistic, 0.89; Brier score, 0.026), respectively. Significant predictors of symptomatic PTOA included increased pain scores, older age, increased body mass index, increased time to ACLR, total number of arthroscopic surgeries before the diagnosis of arthritis, positive pivot-shift test after reconstruction, concomitant chondral injury, secondary meniscal tear, early (<250 days) or delayed (>500 days) return to sports or activity, and use of allograft. Significant predictors for TKA included older age, increased pain scores, total number of arthroscopic surgeries, high-demand activity/occupation, hypermobility, higher body mass index, systemic inflammatory disease, increased time to surgery, early (<250 days) or delayed (>500 days) return to sports or activity, and midsubstance tears. The Brier score over time revealed that RSF models outperformed traditional Kaplan-Meier estimators. Conclusion: Machine learning survival models were used to reliably identify patients at risk of developing symptomatic PTOA, and these models consistently outperformed traditional Kaplan-Meier estimators. Strong predictors for the development of PTOA after ACLR included increased pain scores at injury and postoperative visit, older age at injury, total number of arthroscopic procedures, positive postoperative pivot-shift test, and secondary meniscal tear.

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Section: Discussionmentioning

confidence: 93%

Predicting the Risk of Posttraumatic Osteoarthritis After Primary Anterior Cruciate Ligament Reconstruction: A Machine Learning Time-to-Event Analysis

Lu,

Reinholz,

Till

et al. 2023

Am J Sports Med

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“…Both ACL injury and meniscal lesions are known to increase the risk of osteoarthritis and subsequent TKA 8,[36][37][38][39][40] . In the present cartilage cohort, neither meniscal resection nor ACL surgery was associated with an increased risk of knee arthroplasty.…”

Section: Risk Of Arthroplastymentioning

confidence: 99%

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

Birkenes

Furnes

Lygre

et al. 2023

Journal of Bone and Joint Surgery

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Background:Focal cartilage lesions are common in the knee. The risk of later ipsilateral knee arthroplasty remains unknown. The purposes of the present study were to evaluate the long-term cumulative risk of knee arthroplasty after arthroscopic identification of focal cartilage lesions in the knee, to investigate the risk factors for subsequent knee arthroplasty, and to estimate the subsequent cumulative risk of knee arthroplasty compared with that in the general population.Methods:Patients who had undergone surgical treatment of focal cartilage lesions at 6 major Norwegian hospitals between 1999 and 2012 were identified. The inclusion criteria were an arthroscopically classified focal cartilage lesion in the knee, an age of ≥18 years at the time of surgery, and available preoperative patient-reported outcomes (PROMs). The exclusion criteria were osteoarthritis or “kissing lesions” at the time of surgery. Demographic data, later knee surgery, and PROMs were collected with use of a questionnaire. A Cox regression model was used to adjust for and investigate the impact of risk factors, and Kaplan-Meier analysis was performed to estimate cumulative risk. The risk of knee arthroplasty in the present cohort was compared with that in the age-matched general Norwegian population.Results:Of the 516 patients who were eligible, 322 patients (328 knees) consented to participate. The mean age at the time of the index procedure was 36.8 years, and the mean duration of follow-up was 19.8 years. The 20-year cumulative risk of knee arthroplasty in the cartilage cohort was 19.1% (95% CI, 14.6% to 23.6%). Variables that had an impact on the risk of knee arthroplasty included an ICRS grade of 3 to 4 (hazard ratio [HR], 3.1; 95% CI, 1.1 to 8.7), an age of ≥40 years at time of cartilage surgery (HR, 3.7; 95% CI, 1.8 to 7.7), a BMI of 25 to 29 kg/m2 (HR, 3.9; 95% CI, 1.7 to 9.0), a BMI of ≥30 kg/m2 (HR, 5.9; 95% CI, 2.4 to 14.3) at the time of follow-up, autologous chondrocyte implantation (ACI) at the time of the index procedure (HR, 3.4; 95% CI, 1.0 to 11.4), >1 focal cartilage lesion (HR, 2.1; 95% CI, 1.1 to 3.7), and a high preoperative visual analog scale (VAS) score for pain at the time of the index procedure (HR, 1.1; 95% CI, 1.0 to 1.1). The risk ratio of later knee arthroplasty in the cartilage cohort as compared with the age-matched general Norwegian population was 415.7 (95% CI, 168.8 to 1,023.5) in the 30 to 39-year age group.Conclusions:In the present study, we found that the 20-year cumulative risk of knee arthroplasty after a focal cartilage lesion in the knee was 19%. Deep lesions, higher age at the time of cartilage surgery, high BMI at the time of follow-up, ACI, and >1 cartilage lesion were associated with a higher risk of knee arthroplasty.Level of Evidence:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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“…However, in chronically ACL deicient knees, the incidence of medial meniscus (MM) pathology is higher, which is thought to be due to the increased anterior and rotatory movement that occurs in the ACL deicient knee [1,46]. Partial and total meniscectomy has been associated with an increased risk of knee osteoarthritis [29,33]. Total removal of the MM results in a 100% increase in contact Extended author information available on the last page of the article 1 3 stresses and a total lateral meniscectomy between a 200 and 300% increase in contact stresses on the articular cartilage [14].…”

Section: Introductionmentioning

confidence: 99%

“…Partial and total meniscectomy has been associated with an increased risk of knee osteoarthritis [29, 33]. Total removal of the MM results in a 100% increase in contact stresses and a total lateral meniscectomy between a 200 and 300% increase in contact stresses on the articular cartilage [14].…”

Section: Introductionmentioning

confidence: 99%

Delaying ACL reconstruction is associated with increased rates of medial meniscal tear

Erard¹,

Cance²,

Shatrov³

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender. Methods Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 . Meniscal tear was assessed during arthroscopy using the ISAKOS classiication. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni-and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3-6 months (388; 29%), 6-12 months (248; 19%) and > 12 months (254; 19%). Results Delaying ACLR > 12 months signiicantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3-or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not signiicantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was signiicantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001). Conclusion Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury. Level of Evidence Level III.

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Predictors of Osteoarthritis Development at a Median 25 Years After Anterior Cruciate Ligament Reconstruction Using a Patellar Tendon Autograft

Cited by 19 publications

References 51 publications

Predicting the Risk of Posttraumatic Osteoarthritis After Primary Anterior Cruciate Ligament Reconstruction: A Machine Learning Time-to-Event Analysis

Predicting the Risk of Posttraumatic Osteoarthritis After Primary Anterior Cruciate Ligament Reconstruction: A Machine Learning Time-to-Event Analysis

The Long-Term Risk of Knee Arthroplasty in Patients with Arthroscopically Verified Focal Cartilage Lesions

Delaying ACL reconstruction is associated with increased rates of medial meniscal tear

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