Anterior Cruciate Ligament Reconstruction and the Long Term Incidence of Gonarthrosis

Abstract

Knee ligament injuries are common in sport. A rupture of the anterior cruciate ligament (ACL) is the most serious of these injuries because it may cause long term disability. In this literature review, the frequency of post-traumatic gonarthrosis is examined. There are few long term prospective studies but a number of retrospective studies with follow-up times between 5 and 20 years have been published. These studies show that radiographic gonarthrosis is significantly increased after all knee injuries compared with the uninjured joint of the same patient. Isolated meniscus rupture and subsequent repair, or partial or total ruptures of the ACL without major concomitant injuries, seem to increase the risk 10-fold (15 to 20% incidence of gonarthrosis) compared with an age-matched, uninjured population (1 to 2%). Meniscectomy in a joint with intact ligaments further doubles the risk of gonarthrosis (30 to 40%), and 50 to 70% of patients with complete ACL rupture and associated injuries have radiographic changes after 15 to 20 years. Thus, an ACL rupture combined with meniscus rupture or other knee ligament injuries results in gonarthrosis in most patients. Ten to 20 years after ACL injury, gonarthrosis often presents as a slight joint space reduction or, occasionally, joint space obliteration (Ahlbäck grades I to II), but is usually not associated with major clinical symptoms. According to the few longitudinal studies, the progress of gonarthrosis is slow, and in some cases the condition seems to remain stable. Time is an important determinant for the degree of gonarthrosis and problems demanding treatment may be encountered only at > 30 years after the initial accident.

What are the risk factors in the development of osteoarthritis following ACL reconstruction?

“…However, we found no correlation between instability and OA. Similar conclusions were reached by Sommerlath et al [3] and Gillquist and Messner [2].…”

“…However, we found no correlation between instability and OA. Similar conclusions were reached by Sommerlath et al [3] and Gillquist and Messner [2].Roe et al [4] reported that ACL reconstruction patients with PT autograft showed higher OA incidence than those with hamstring autograft. However in our study we used a patellar tendon autograft in all cases and we have provided no information about the relationship between OA and graf t choice (PT or hamstring).…”

Cruciate ligament integrity in osteoarthritis of the knee

“…Because there is little potential for spontaneous recovery of the ACL following complete rupture (18) and OA frequently develops in these individuals, surgical intervention would appear logical to maintain knee joint stability. Despite this, studies have suggested that surgery may actually hasten the development of OA (4).…”

Development and Validation of a 3-D Model to Predict Knee Joint Loading During Dynamic Movement

“…Apart from the obvious acute injury effects, knee joint musculoskeletal injury often potentiates the likelihood of significant long-term debilitation. It has been shown for example, that ACL injury presents an 8 -10 fold increase in the long-term incidence of osteoarthritis [4,5].…”