Anterior cruciate ligament deterioration correlates with patella osteoarthritis

Abstract

Purpose The correlation between anterior cruciate ligament (ACL) condition and patella osteoarthritic (OA) changes has not been well reported. The aim of this study was to reveal the correlation between ACL deterioration and the morphology of OA changes in the patella. The hypothesis was that significant correlation between ACL deterioration and patella OA morphology would be revealed in this study. Methods Two hundred ninety-one cadaveric knees from 151 cadavers were included in this study with a median age of 83 years (54-98). Knees were opened with a sub-vastus approach and the ACL condition was classified as intact or deteriorated. Patella OA lesions were classified using Han's method: type 1, no or minimal lesion; type 2, medial facet lesion without involvement of the ridge; type 3, lateral facet lesion without involvement of the ridge; type 4, lesion involving the ridge only; type 5, medial facet lesion with involvement of the ridge; type 6, lateral facet lesion with involvement of the ridge; and type 7, global lesion. OA depth evaluation was performed following Outerbridge's classification. Statistical analysis of the collected data was performed using generalized estimating equations (GEE). Results The ACL was intact in 277 knees and deteriorated in 14 knees. Patella OA lesions were observed as follows: type 1, 29 %; type 2, 15 %; type 3, 2 %; type 4, 12 %; type 5, 18 %; type 6, 2 %; and type 7, 22 %. Outerbridge's classification of over grade 2 OA depth was observed in 73.5 % of subjects. When patella OA was divided into types 1-4 and types 5-7, ACL deterioration was correlated with the occurrence of type 5-7 patella OA [OR 6.44, 95%CI 2.27-18.25, p =0.000]. When patella OA was divided into types 1-6 and type 7, ACL deterioration was correlated with the occurrence of type 7 patella OA [OR 6.02, p =0.000]. When patella OA depth was divided into grades 1-3 and grade 4, ACL deterioration was highly correlated with the occurrence of grade 4 patella OA [OR 9.31, p =0.025]. Conclusion ACL deterioration is a strong risk factor of wider and deeper OA changes in the patella. For clinical relevance, subjects with ACL tear should be aware of the progression of patella OA.

Long-term Effect of a Single Subcritical Knee Injury: Increasing the Risk of Anterior Cruciate Ligament Rupture and Osteoarthritis

“…Occasional deformation of the patellar surface was noted in an ACL rupture model induced by a similar mechanical loading of the joint. 16 ACL pathology is highly correlated with patellar OA, 26 and osteochondral lesions are more common in the patellofemoral than tibiofemoral compartment of patients after ACL injury, 26,49 suggesting that this is a loading/impact area in naturally occurring knee injuries that compromise the ACL. Both osteochondral lesions in mice are thus likely a direct consequence of the initial subcritical injury, given the unchanged knee stability initially and very limited progression in cartilage damage with time after injury.…”

Validation of the Macroscopic Anterior Cruciate Ligament Status Using the Oxford Classification System in Relation to Cartilage Defects on the Medial Tibial Plateau in Osteoarthritic Knees

“…9 10 12 Some studies classified the ACL into three grades (normal, abnormal but present, absent; 13 intact, indeterminate or disrupted; 14 and intact, attenuated or deficient), 15 and others classified into four (intact; partial tear or deterioration of the AM bundle; partial tear or deterioration of the PL bundle; and complete tear or deterioration). 16 Although their classification systems have reportedly been related to cartilage defects, none of these have been widely used. The Oxford classification showed excellent interobserver reproducibility (Kappa = 0.81) and demonstrated a significant relationship between the location and size of the cartilage defect.…”