The development of long-term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction

Keays, Susan L.; Newcombe, Peter; Bullock-Saxton, Joanne; Keays, Anthony C.

doi:10.1007/s00402-022-04662-4

Cited by 7 publications

(4 citation statements)

References 53 publications

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“…There is considerable controversy surrounding the role for surgery in older patient populations with ACL tears [3, 8, 9, 30, 31, 35, 37, 38]. Patients under the age of 40 who undergo nonsurgical management of these injuries are at increased risk of sustaining subsequent meniscal and chondral injuries and may develop knee osteoarthritis at a higher rate than those who receive ACLR [3, 10, 17, 18, 22, 23]. As such, ACLR is the preferred management for young and active patients.…”

Section: Discussionmentioning

confidence: 99%

Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older

Puzzitiello

Sylvia

Perrone

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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Purpose To perform a predictive analysis to identify preoperative patient factors associated with failure to achieve a newly deined patient acceptable symptom state (PASS) for the International Knee Documentation Committee (IKDC) Score after anterior cruciate ligament reconstruction (ACLR) in patients aged ≥ 40 years with a minimum of 2-year follow-up. Methods This was a secondary analysis of a retrospective review of all patients aged 40 years or older receiving a primary allograft ACLR at a single institution between the years of 2005 and 2016, with 2-year minimum follow-up. Using an updated PASS threshold of 66.7 for the International Knee Documentation Committee (IKDC) score previously established for this patient cohort, a univariate and multivariate analysis was performed to identify preoperative patient characteristics predictive of failure to achieve PASS. Results A total of 197 patients with a mean follow-up of 6.2 ± 2.1 years (range 2.7 -11.2) were included in the analysis (48.5 ± 5.6 years, 51.8% female, Body Mass Index (BMI) 25.9 ± 4.4). PASS was achieved by 162 patients (82.2%). Patients who failed to achieve PASS more often had lateral compartment cartilage defects (P = 0.001) and lateral meniscus tears (P = 0.004), higher BMIs (P = 0.004), and Workers' Compensation status (P = 0.043) on univariable analysis. Factors predictive of failure to achieve PASS on multivariable analysis included BMI and lateral compartment cartilage defect (OR 1.12 [1.03-1.23], P = 0.013; OR 5.1 [1.87-13.9], P = 0.001). Conclusion Among patients ≥ 40 years who receive a primary allograft ACLR, patients who fail to achieve PASS more often had lateral compartment cartilage defects and higher BMIs. Level of evidence Level IV.

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Section: Discussionmentioning

confidence: 99%

Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older

Puzzitiello

Sylvia

Perrone

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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“…Other considerations for long term outcomes include development of osteoarthritis, continued pain, and return to prior activity level. Patients may be more likely to develop tibiofemoral osteoarthritis following BPTB compared to HT autograft, but the evidence is mixed ( 91 - 93 ). There is also some evidence that anterior knee pain and pain with kneeling is more common at long-term follow-up after BPTB autograft ( 94 - 98 ).…”

Section: Discussionmentioning

confidence: 99%

Postoperative considerations based on graft type after anterior cruciate ligament reconstruction a narrative review

Leung¹,

DeSandis²,

O’Brien³

et al. 2023

Ann Joint

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Background and Objective Graft selection for anterior cruciate ligament reconstruction (ACLR) affects rehabilitation throughout the course of postoperative care. Methods A search of PubMed and EBSCO was performed and abstracts independently reviewed by two authors. This search was also supplemented with additional evidence relevant to each phase of ACLR rehabilitation. Key Content and Findings Direct implications of graft type on clinical decisions vary throughout treatment phases, transitioning from potential differences in acute postoperative pain management immediately after surgery to facilitating sufficient and appropriate lower extremity loading in subsequent weeks. Regardless of graft type, surgical limb weakness persists throughout the course of rehabilitation; however, harvest site selection for autografts contributes to disproportionate weakness of the harvested muscle group and the potential for surgical-induced tendinopathy. In later phases of rehabilitation, as athletes are transitioning into return to sport (RTS), treatment decisions and protocols are less affected by graft type but expectations for meeting clinical milestones and the time required to do so does differ between graft types. Conclusions Targeted strengthening interventions to address muscle weakness following graft harvest in autografts should be continued throughout the rehabilitation process. Lingering deficits in quadriceps strength symmetry may also influence time to meet progression and RTS criteria following graft harvest from the extensor mechanism.

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“… 24 An ACL injury is a well-known risk factor for developing knee osteoarthritis (OA), but it is uncertain whether ACL reconstruction (ACLR) can lower the risk of developing OA. 7 , 11 , 14 , 19 , 24 Between 25% and 65% of all ACL ruptures have a combined meniscal injury, which further increases the risk of developing OA. 24 A lower prevalence of secondary meniscal injuries has been reported in patients after ACLR compared with those treated nonoperatively, 11 , 19 and secondary analysis of magnetic resonance imaging data from a randomized controlled trial also suggested a lower risk of subsequent meniscal damage after primary reconstruction.…”

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confidence: 99%

Outcomes >30 Years After Initial Nonoperative Treatment of Anterior Cruciate Ligament Injuries

Hellberg,

Kostogiannis,

Stylianides

et al. 2024

Am J Sports Med

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Background: It is unclear how anterior cruciate ligament (ACL) reconstruction (ACLR) affects the development of osteoarthritis (OA). This uncertainty is partly caused by the lack of long-term studies on ACL injuries treated primarily without reconstruction and the underreporting of symptomatic OA. Purpose: To determine (1) the knee function, symptoms, and activity level, as well as the presence of radiographic and symptomatic OA; (2) how these clinical outcomes have changed over time; and (3) the frequency of subsequent knee surgeries after the index ACL injury in a cohort of patients with ACL injuries treated primarily without reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A total of 100 patients underwent initial nonoperative treatment >30 years ago (mean, 33.2 ± 1.4 years). Of these, 81 patients (mean age, 59 ± 8 years) completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale, and Tegner Activity Scale. Seventy-three patients underwent radiography to evaluate tibiofemoral and patellofemoral OA in the ACL-injured knee. Patients only underwent late ACLR if they experienced insufficient knee stability. Results: At 33 years after the ACL injury, the KOOS Activities of Daily Living subscore was better than population-based reference values, but scores were similar for the remaining KOOS subscales. Furthermore, 65% of patients had a good or excellent Lysholm score (≥84 points). The Tegner score decreased 4 points from before the injury to 33-year follow-up ( P < .001). Most patients (75%) had evidence of radiographic tibiofemoral and/or patellofemoral OA, but only 38% were classified as having symptomatic OA (defined as radiographic OA in combination with a symptomatic knee according to cutoffs on the KOOS). Approximately 50% underwent meniscal surgery, and 29% subsequently underwent ACLR for recurrent instability. There were 2 patients who underwent total knee replacement. Conclusion: Despite a high prevalence of radiographic OA, patients achieved acceptable subjective knee function and had a relatively low prevalence of symptomatic OA at >30 years after an ACL injury when an initial nonoperative treatment strategy was employed.

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The development of long-term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction

Cited by 7 publications

References 53 publications

Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older

Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older

Postoperative considerations based on graft type after anterior cruciate ligament reconstruction a narrative review

Outcomes >30 Years After Initial Nonoperative Treatment of Anterior Cruciate Ligament Injuries

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