Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis

Claes, Steven; Hermie, Laurens; Verdonk, René; Bellemans, Johan; Verdonk, Peter

doi:10.1007/s00167-012-2251-8

Cited by 203 publications

(212 citation statements)

References 50 publications

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“…Individuals with ACL injury are at high risk of poor longterm outcomes (eg, osteoarthritis, [18][19][20] knee pain, 21 diminished quality of life [21][22][23] ), and early symptoms predict more severe knee pain and symptoms 6 years after an ACL injury. 24 Furthermore, preoperative knee and body pain are important predictors of postsurgical outcomes 1 or 2 years after an ACL reconstruction.…”

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confidence: 99%

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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Context: After an anterior cruciate ligament (ACL) injury, a majority of patients have a traumatic bone marrow lesion (BML, or bone bruise). The clinical relevance of posttraumatic lesions remains unclear.Objective: To explore the cross-sectional associations between traumatic BML volume and self-reported knee pain and symptoms among individuals within 4 weeks of ACL injury.Design: Cross-sectional exploratory analysis of a randomized clinical trial.Setting: Orthopaedic departments at 2 hospitals in Sweden. Patients or Other Participants: As part of a randomized trial (knee anterior cruciate ligament nonoperative versus operative treatment [KANON] study), 121 young active adults (74% men, age ¼ 26 6 5 years, height ¼ 1.8 6 0.1 m, weight ¼ 76 6 13 kg) with an ACL tear were studied.Main Outcome Measure(s): The BML volume in the proximal tibia and distal femur was segmented using magnetic resonance images obtained within 4 weeks of injury. A radiologist evaluated the presence of depression fractures on the images. Pain and symptoms of the injured knee (Knee Injury and Osteoarthritis Outcome Score [KOOS] pain and symptoms subscales) were obtained the same day as imaging. We used linear regression models to assess the associations.Results: Most knees had at least 1 BML (96%), and the majority (57%) had a depression fracture. Whole-knee BML volume was not related to knee pain for the entire cohort (b ¼ À0.09, P ¼ .25). Among those without a depression fracture, larger whole-knee BML volume was associated with increased knee pain (b ¼ -0.46, P ¼ .02), whereas no association was found for those with a depression fracture (b ¼ 0.0, P ¼ .96). Larger medial (b ¼ -0.48, P ¼ .02) but not lateral (b ¼ -0.03, P ¼ .77) tibiofemoral BML volume was associated with greater pain. We found no association between BML volume and knee symptoms.Conclusions: We confirmed the absence of relationships between whole-knee BML volume and pain and symptoms within 4 weeks of ACL injury. Our findings extend previous reports in identifying weak associations between larger BML volume in the medial compartment and greater pain and between BML volume and greater pain among those without a depression fracture.Key Words: knee injuries, magnetic resonance imaging, sprains, trauma, patient-reported outcomes Key PointsWithin 4 weeks of anterior cruciate ligament injury, total-knee bone marrow lesion volume and self-reported pain and symptoms were not associated. More pain was weakly related to greater medial compartment and greater total-knee bone marrow lesion volume and to greater bone marrow lesion volume among participants without a depression fracture.

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confidence: 99%

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Driban

Lohmander

Frobell

2017

Journal of Athletic Training

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“…Physical therapists often see clients who ''feel'' ready for return to sport within 5 months after reconstruction and whose outcome measure scores also indicate readiness, yet these underlying processes are not optimized, and return to sport may therefore lead to further joint damage. 19 In Cupido and colleagues' study, while ROM and pain measures provided evidence of recovery, LEFS scores had not recovered after 26 weeks. In addition, joint biomechanics and biochemical markers of tissue degradation may not normalize until after 26 weeks post injury; 6,8 this has implications for current pathomechanical frameworks proposed for the aetiology of knee osteoarthritis (OA), a significant concern for anyone who has sustained an ACL ligament rupture.…”

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confidence: 90%

Clinician's Commentary on Cupido et al.

Rutherford

2014

Physiotherapy Canada

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“…Similarly, a large study of 1434 individuals found a relationship between an increased period of time from injury to surgery and higher rates of concomitant joint injury when presenting for ACLR, including injury to meniscus and joint surfaces (Ralles, Agel, Obermeier, & Tompkins, 2015). People with concomitant injury to other knee structures at the time of ACLR report higher rates of osteoarthritis 10 to 20 years later (Claes et al, 2013;Keays, 2010;Magnussen et al, 2009;Murray et al, 2012;Øiestad et al, 2009;van Meer et al, 2015) and poorer patient-reported outcomes after ACLR including more knee pain, symptoms, poorer function and reduced QOL (Barenius et al, 2010;Cox et al, 2014;Dunn et al, 2015;Gerhard et al, 2012;Neuman et al, 2008;Røtterud et al, 2012;Røtterud et al, 2013).…”

Section: Time From Injury To Surgerymentioning

confidence: 99%

“…Concomitant cartilage and meniscus injury with or without surgical repair has also been associated with higher rates of early-onset knee osteoarthritis compared with an isolated ACL rupture (Claes, Hermie, Verdonk, Bellemans, & Verdonk, 2013;Keays, 2010;Magnussen, Mansour, Carey, & Spindler, 2009;Murray et al, 2012;Øiestad et al, 2009;van Meer et al, 2015). Additionally, worse outcomes (reduced physical activity level and knee function, more pain and symptoms)…”

Section: Concomitant Joint Injurymentioning

confidence: 99%

“…Concomitant meniscus and cartilage injury have been associated with an increased likelihood for self-reported knee symptoms, pain, function and poorer QOL 2 to 16 years after ACLR (Barenius et al, 2010;Cox et al, 2014;Dunn et al, 2015;Gerhard et al, 2012;Neuman et al, 2008;Røtterud et al, 2012;Røtterud et al, 2013). Concomitant meniscus or cartilage injury or surgery have also been related to increased rates of post-traumatic knee osteoarthritis following ACLR (Claes et al, 2013;Keays, 2010;Magnussen et al, 2009;Murray et al, 2012;Øiestad et al, 2009;van Meer et al, 2015).…”

Section: Time From Injury To Surgerymentioning

confidence: 99%

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Long-term quality of life following anterior cruciate ligament injury and reconstruction

Filbay¹

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The anterior cruciate ligament (ACL) serves to stabilise the knee complex and prevent intraarticular knee structures from sustaining damage during multiaxial, high impact movement. An ACL rupture most commonly occurs in adolescents and young adults taking part in competitive sports and causes substantial disruption to the knee joint. Anterior cruciate ligament reconstruction (ACLR) is the most common treatment offered to ACL-ruptured individuals worldwide. Individuals undergoing this surgery often have high expectations that rarely match surgical outcomes. Return to sport rates are low, re-injury fears are widespread and many individuals develop knee osteoarthritis within ten years of ACLR. This mismatch between expectations and actual outcomes has great potential to impact longer-term quality of life (QOL). The primary aims of this thesis were to: (i) generate a detailed picture of longer-term QOL following ACLR, and (ii) identify factors related to longer-term QOL in people with knee pain, symptoms or functional limitations following ACLR.The first study in this thesis is a systematic review that revealed impaired knee-related QOL at 5 to 20 years after ACLR. However, it became evident that research into factors impacting upon QOL in this population was scarce. The systematic review found that having a subsequent knee injury, an additional knee surgery after ACLR, and developing severe radiographic osteoarthritis were associated with worse QOL outcomes. The second study in this thesis is a systematic review that investigated QOL more than five years after ACL rupture in individuals who remained ACL-deficient (did not undergo ACLR) and compared QOL between ACLdeficient and ACL-reconstructed groups. This systematic review found that ACL-deficient individuals reported comparable QOL outcomes to those who underwent ACLR 5 to 25 years previously. All studies that reported QOL after ACLR included asymptomatic participants without knee difficulties, which may underestimate the degree of QOL impairment experienced by people with ongoing knee difficulties.The third study in this thesis used a cross-sectional design to describe QOL outcomes in 162 individuals with knee pain, symptoms or functional limitations 5 to 20 years following ACLR.It showed that individuals who did not return to sport after ACLR reported poorer knee-related and health-related QOL, compared to people who returned to pre-injury levels of sport. Higher body mass index (BMI) and subsequent surgery were also related to worse QOL after ACLR.This was the first study to show that return to sport was associated with QOL impairment more than five years after ACLR. However, quantitative assessment of QOL may overlook important considerations with regard to an individual's life priorities, expectations, values and concerns.To provide a detailed understanding of QOL following ACLR, qualitative interviews were performed with 17 individuals with knee difficulties 5 to 20 years following ACLR. This was the first qualitative study to explore QOL following...

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Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis

Abstract: Level III.

Cited by 203 publications

References 50 publications

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Posttraumatic Bone Marrow Lesion Volume and Knee Pain Within 4 Weeks After Anterior Cruciate Ligament Injury

Clinician's Commentary on Cupido et al.

Long-term quality of life following anterior cruciate ligament injury and reconstruction

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