An overall improvement in knee function outcomes was detected from 6 months to 10 to 15 years after ACL reconstruction for both those with isolated and combined ACL injury, but significantly higher prevalence of radiographic knee osteoarthritis was found for those with combined injuries.

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logistic regressions to determine if an incident knee injury was associated with the outcome of rapid KOA or non-rapid KOA after adjusting for age, sex, body mass index (BMI), presence of static knee malalignment, and systolic blood pressure. We also conducted a secondary analysis by replicating these analyses with 71 additional individuals who had rapid KOA but their contralateral knee had prevalent OA at baseline. This permitted us to test our hypothesis in a larger sample size. Results: Individuals with rapid KOA (n ¼ 54) tended to be older and have greater baseline BMI and systolic blood pressure (Table). Individuals with rapid KOA had a higher incidence of knee injuries, particularly within the 12 months prior to presenting with KL Grade ¼ 3 or 4. An incident knee injury between baseline and meeting our study definition was associated with rapid KOA (odds ratio [OR] ¼ 3.14, 95% confidence interval [CI] ¼ 1.61 to 6.13) but not non-rapid KOA (OR ¼ 1.08, 95% CI ¼ 0.65 to 1.81) after adjusting for sex, baseline age, body mass index, presence of static knee malalignment, and systolic blood pressure. Furthermore, an incident knee injury within the year prior to meeting the study definition was associated with rapid KOA (OR ¼ 8.46, 95% CI ¼ 3.93 to 18.21) and non-rapid KOA (OR ¼ 3.12, 95% CI ¼ 1.65 to 5.89) even after adjustments. Our secondary analyses supported our primary findings. Conclusions: Recent knee injuries are associated with rapid KOA. Most concerning is that certain injuries may initiate a rapid cascade towards joint failure in less than one year. It will be important to determine which injuries increase the risk of non-rapid and rapid KOA.

Patients with chronic low back pain who followed cognitive intervention and exercise programs improved significantly in muscle strength compared with patients who underwent lumbar fusion. In the lumbar fusion group, density decreased significantly at L3-L4 compared with the exercise group.

Risberg, M. A. (2013). The prevalence of patellofemoral osteoarthritis 12 years after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 21,[942][943][944][945][946][947][948][949] Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på link.springer.com: http://dx.doi.org/10. 1007/s00167-012-2161-9 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. The original publication is available at link.springer.

Objective. To identify risk factors for knee osteoarthritis (OA) 10 -15 years after anterior cruciate ligament (ACL) reconstruction. We hypothesized that quadriceps muscle weakness after ACL reconstruction would be a risk factor for radiographic and symptomatic radiographic knee OA 10 -15 years later. Methods. Subjects with ACL reconstruction (n ‫؍‬ 258) were followed for 10 -15 years. Subjects with unilateral injury at the 10 -15-year followup were included in the present study. Outcomes included the Cincinnati knee score, knee joint laxity, hop performance, and isokinetic muscle strength tests at 6 months, 1 year, and 2 years postoperatively. At the 10 -15-year followup, radiographs were taken and graded according to the Kellgren/Lawrence classification (range 0 -4). Results. Of the 212 subjects (82%) assessed at the 10 -15-year followup, 164 subjects had unilateral injury. The mean ؎ SD age at ACL reconstruction was 27.4 ؎ 8.

Background: Progression of tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA) and changes in knee function more than 15 years after anterior cruciate ligament reconstruction (ACLR) are not well understood. Purpose: To examine the progression of knee OA and changes in symptoms and function in isolated and combined injuries from 15 to 20 years after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 210 subjects with ACLR were prospectively followed. At the 15- and 20-year follow-ups, radiographs were obtained and classified by the Kellgren and Lawrence (K-L) grading system. Symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) as well as isokinetic quadriceps and hamstring muscle strength tests. Results: There were 168 subjects (80%) who returned for the 20-year follow-up, with a mean (±SD) age of 45 ± 9 years, mean body mass index of 27 ± 4, and median Tegner activity level of 4 (range, 0-9). The prevalence of radiographic TF and PF OA at the 20-year follow-up was 42% and 21%, respectively. Patients with ACL injuries and other combined injuries had significantly higher prevalence of radiographic TF OA compared with those who had isolated ACL injury ( P < .0001). There was a 13% increase in radiographic TF OA ( P = .001) and an 8% increase in PF OA ( P = .015) from the 15- to the 20-year follow-up. A significant deterioration in knee symptoms and function was observed on the KOOS subscales ( P ≤ .01), with the exception of quality of life ( P = .14), as well as a decrease in quadriceps muscle strength and hamstring muscle strength ( P < .0001). Conclusion: The prevalence of radiographic TF and PF OA was 42% and 21%, respectively. A significantly higher prevalence of TF OA was found for subjects with combined injuries compared with those who had isolated ACL injury. The majority of the subjects were stable radiographically over the 5 years between follow-ups. A statistically significant deterioration in symptoms and function was noted, but the mean changes were of questionable clinical importance.

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