Assessment of osteoarthritis after reconstruction of the anterior cruciate ligament

Abstract

We used single-photon emission computed tomography (SPECT) to determine the long-term risk of degenerative change after reconstruction of the anterior cruciate ligament (ACL). Our study population was a prospective series of 31 patients with a mean age at injury of 27.8 years (18 to 47) and a mean follow-up of ten years (9 to 13) after bone-patellar tendon-bone reconstruction of the ACL. The contralateral normal knee was used as a control. All knees were clinically stable with high clinical scores (mean Lysholm score, 93; mean Tegner activity score, 6). Fifteen patients had undergone a partial meniscectomy and ACL reconstruction at or before reconstruction of their ACL. In the group with an intact meniscus, clinical symptoms of osteoarthritis (OA) were found in only one patient (7%), who was also the only patient with marked isotope uptake on the SPECT scan compatible with OA. In the group which underwent a partial meniscectomy, clinical symptoms of OA were found in two patients (13%), who were among five (31%) with isotope uptake compatible with OA. Only one patient (7%) in this group had evidence of advanced OA on plain radiographs. The risk of developing OA after ACL reconstruction in this series is very low and lower than published figures for untreated ACL-deficient knees. There is a significant increase (p < 0.05) in degenerative change in patients who had a reconstruction of their ACL and a partial meniscectomy compared with those who had a reconstruction of their ACL alone.

Epidemiology of Posttraumatic Osteoarthritis

“…The prevalence of PTOA after ACL injury is conflicting because of the different classification methods for defining OA in the literature. 28 For patients with isolated ACL injuries, PTOA prevalence ranges from 0% to 39%, [29][30][31][32][33][34][35][36] whereas prevalence is higher among individuals with combined ACL and meniscal injuries (21%-100%). 31,34,[36][37][38] However, Oiestad et al 28 suggested that poor methodologic quality of studies has led to overestimation of PTOA rates and that prevalence may be closer to 13% in patients with isolated ACL injuries and between 21% and 48% in those with combined ACL and meniscal injuries who are at least 10 years postinjury.…”

SPECT‐CT compared with conventional imaging modalities for the assessment of the varus and valgus malaligned hindfoot

“…Blood-pool images of the ankles and the hindfoot were compared with those of the contra-lateral side, and graded from 0 to 2: grade 0, no increased radioisotope uptake; grade 1, minimal increased uptake; or grade 2, markedly increased uptake. This classification is a modification of the grading system used by Hart et al 19 for the examination of the knee joint. Delayed scintigraphy was performed 4.5 h after radioisotope injection.…”

How to evaluate bone tunnel widening after ACL reconstruction - a critical review

“…In the last decade magnetic resonance imaging (MRI) and computed tomography (CT) were increasingly used for evaluation of tunnel widening, as these promised higher accuracy and lower inter-or intra-observer variabilities 9,10,18,45 . Only few Authors have used bone scans, single-photon emission tomography (SPECT) or multi-modality imaging such as SPECT/CT to follow-up their patients after ACL reconstruction 11,13 . A variety of different algorithms and measurement methods using conventional radiographs, MRI or CT, whether in 2D or 3D have been described to evaluate bone tunnel widening 1-4, 6-10, 13, 15, 17-20, 22, 23, 26, 28-33, 37-47 .…”