Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review

Culvenor, Adam G; Cook, Jill; Collins, Natalie J; Crossley, Kay M

doi:10.1136/bjsports-2012-091490

Cited by 127 publications

(137 citation statements)

References 118 publications

Supporting

Mentioning

131

Contrasting

Order By: Relevance

“…More specifically, PF arthritis presents constantly with AKP, and other authors have documented that patients with established PF arthritis that required surgical treatment had a history of significantly higher AKP than controls (22 % vs 6 %, p<0.001) [48]. The risk of long-term arthritis after ACL reconstruction has been questioned in the literature, and the possibility of PF arthritis following ACL reconstruction has been recently re-emphasized [49][50][51]. Järvelä et al documented mild to severe PF osteoarthritis in 88.6 % of their patients seven years after ACL reconstruction [49] and also correlated the increased incidence of AKP in this group but, unfortunately, without evaluating for the presence of trochlear dysplasia in these patients [6].…”

Section: Discussionmentioning

confidence: 99%

“…Oiestad et al documented 26 % of established PF arthritis 12 years after ACL reconstruction, again without checking for the pre-operative presence of similar radiological findings such as trochlear dysplasia [51]. Most recently, Culvenor et al reviewed the increased incidence of PF arthritis with ACL reconstruction and recommended prevention and treatment strategies with attention to rehabilitation protocols and quadriceps and hamstring muscles coordination in order to minimize this complication [50]. Trochlear dysplasia has been found to be a strong associating factor for future PF arthritis [12,[52][53][54].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Ntagiopoulos¹,

Bonin²,

Sonnery‐Cottet

et al. 2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

Purpose The purpose of the present epidemiologic study is to record the radiographic presence of trochlear dysplasia and patella alta in patients who undergo anterior cruciate ligament (ACL) reconstruction as a potential underlying factor for postoperative anterior knee pain (AKP). Methods All consecutive cases of skeletally-mature ACLdeficient knees that would undergo ACL reconstruction in three different hospitals were prospectively included during a six-month period. Inclusion criteria were acute and subacute ACL injury with no previous ipsilateral knee operation. Patients with chronic ACL tears, prior-to-ACL-injury history of patellar instability or other PF disorders were excluded from the study. Results A total of 299 knees were included (mean age 32± ten years). Forty-four (14.7 %) knees had a positive 'crossing sign' in the lateral X-rays and 255 (85.3 %) had no sign of trochlear dysplasia (p<0.01). Among the cases with trochlear dysplasia, 41 (93 %) had type A trochlear dysplasia with the presence only of the 'crossing sign' and three (7 %) had type C trochlear dysplasia. Patellar height results included a mean Caton-Deschamps index of 1.0± 0.14 (0.5-1.4). Twenty (6.6 %) knees had an index of less than 0.8, and two (0.6 %) knees had an index less than 0.6. In contrast, 15 (5.0 %) knees had an abnormal value of more than 1.2, indicating patella alta. ConclusionsThe most important finding of the study is the increased prevalence of trochlear dysplasia and patella alta in patients with ACL injury, when compared to the incidence of trochlear dysplasia and patella alta in the general population in the literature. This finding could sound as an alert of a possible additional risk factor for post-operative anterior knee pain after ACL reconstruction.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Ntagiopoulos¹,

Bonin²,

Sonnery‐Cottet

et al. 2014

International Orthopaedics (SICOT)

View full text Add to dashboard Cite

show abstract

“…2,19,30,35,55 A systematic review showed that more than 10 years after ACL reconstruction, up to 50% had developed radiographic tibiofemoral (TF) OA 35 , but we lack knowledge on the prevalence of patellofemoral (PF) OA in this population. 8,37 The incidence of knee OA increases with age, with the elderly most commonly affected. However, posttraumatic knee OA typically develops in young to middle-aged adults, affecting quality of life as early as the 4 th decade of life.…”

Section: Introductionmentioning

confidence: 99%

Changes in Knee Osteoarthritis, Symptoms, and Function After Anterior Cruciate Ligament Reconstruction

et al. 2016

View full text Add to dashboard Cite

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.

show abstract

“…Our finding that one-third of individuals have MRI-defined OA as early as 1 year after ACLR suggests that the clinical focus of postoperative rehabilitation should include more specific elements aimed at maintaining long-term joint health. Greater awareness of the considerable risk of patellofemoral disease is also warranted, as it has previously been underrecognized (7).…”

Section: Replymentioning

confidence: 99%

Reply

Culvenor

Collins

Guermazi

et al. 2015

Arthritis & Rheumatology

View full text Add to dashboard Cite

Aside from potential overestimation of the knee OA incidence rate, we are concerned about the reliability of some other conclusions of the study. Culvernor et al state that their data extend those of recent MRI studies suggesting that ACLR does not restore a knee to normal. This conclusion does not seem to follow from their study, as they reported the incidence rate of early knee OA after ACLR, but not specific features such as stability, function, etc. In addition, they seem to be concluding that reconstruction may not be appropriate in a large proportion of patients with ACL injury. However, this conclusion cannot be supported from a study in which the control group consisted of uninjured asymptomatic individuals. Patients with ACL injury treated with conservative interventions rather than with reconstruction may have been a more appropriate control group.Besides the above, some other issues need to be mentioned. First, the authors did not report whether the ACL-injured patients also had collateral ligament injuries, which may have affected the results (3). Second, the authors conclude that the presence of OA 1 year following ACLR was more common than previously recognized (31% of individuals had either patellofemoral or tibiofemoral OA). However, it was already reported, in a recent meta-analysis, that of the 16 included studies, 28% of patients showed radiologic signs of OA (4), and that associated meniscal resection dramatically increased the risk of developing OA. Third, there may be other confounders, such as intraarticular injection of hyaluronic acid.We respect the contributions of the authors. We would look forward to seeing the results of an extension of this study over a longer followup period and would also be very interested in their responses regarding the issues raised herein. ReplyTo the Editor: We appreciate Dr. Zeng and colleagues' interest in our article and would like to respond to their comments and expand on some key aspects of our study.The central point raised by Zeng et al appears to concern a possible overestimation of the rate of early knee OA 1 year following ACLR. In particular, they suggest that the absence of preoperative images in our ACLR group and certain demographic differences in our uninjured control group led to the higher-than-expected OA rate.We acknowledged that we did not have access to preoperative images and hence, some OA features may have preceded the knee trauma. However, several findings counter the likelihood that preexisting OA could have accounted for most of the OA observed at 1 year following ACLR, i.e., 1) our uninjured control group exhibited few features of OA, 2) no overt degeneration (i.e., bony changes such as osteophytes) was observed arthroscopically at the time of ACLR, 3) no association between older age and MRI-diagnosed OA or osteophytes was found, 4) more than one-third of the participants in the ACLR group who were age ,25 years had an osteophyte evidenced on MRI, which would be unexpected in the absence of trauma, and 5) radiographic osteophyt...

show abstract

Is patellofemoral joint osteoarthritis an under-recognised outcome of anterior cruciate ligament reconstruction? A narrative literature review

Cited by 127 publications

References 118 publications

The incidence of trochlear dysplasia in anterior cruciate ligament tears

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Changes in Knee Osteoarthritis, Symptoms, and Function After Anterior Cruciate Ligament Reconstruction

Reply

Contact Info

Product

Resources

About