Patellofemoral osteoarthritis is prevalent and associated with worse symptoms and function after hamstring tendon autograft ACL reconstruction

Abstract

Objectives To evaluate the compartmental distribution of knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR), to determine if patellofemoral or tibiofemoral OA is more strongly associated with knee symptoms and function, and to evaluate the contribution of associated injuries and surgical delay to the development of OA. Methods This cross-sectional study recruited 70 participants who underwent hamstring tendon (HT) ACLR 5-10 years previously. Radiographic OA was assessed according to the Osteoarthritis Research Society International (OARSI) criteria. Knee symptoms were assessed with the Knee Injury and Osteoarthritis Outcome Score (KOOS) and Anterior Knee Pain Scale (AKPS), while function was assessed with three lower limb tasks (hop-for-distance, one-leg rise and side-hop). Multivariate and binary logistic regression analyses were performed to assess the relationship between OA and symptomatic/functional outcomes and associated injuries/ surgical delay, respectively. Results Radiographic OA was observed in the patellofemoral (47%) and tibiofemoral joints (31%). Pain, symptoms and quality of life on the KOOS and the AKPS were associated with severity of patellofemoral OA (standardised regression coefficient (β)=−0.3 to −0.5, p=0.001-0.042), whereas only the KOOS-pain subscale was associated with tibiofemoral OA (β=−0.3, p=0.037). For each functional task, greater patellofemoral OA severity was associated with worse performance, independent of tibiofemoral OA severity (β=−0.3 to −0.4, p=0.001-0.026). Medial meniscal and patellofemoral chondral lesions at surgery were associated with tibiofemoral and patellofemoral OA development at follow-up, respectively, while a longer surgery delay was associated with patellofemoral OA. Conclusions Patellofemoral OA is common following HT ACLR and is associated with worse knee-related symptoms, including anterior knee pain, and decreased functional performance.

Reply

“…It is possible that BMI increased following surgery, secondary to relative inactivity during postoperative recovery. Other factors are likely to play a greater role in the etiology of posttraumatic OA, however, given that we have previously observed no difference in height and weight between subjects with and those without radiographic OA 7 years post-ACLR (6). There also was a clear discrepancy in radiographic features between knees that had undergone ACLR and uninjured contralateral knees.…”

Biomechanical Adaptations After Fatiguing Exercise in Healthy and ACL Reconstructed Individuals

“…43 OA of the medial compartment is three times more likely after ACLR compared to a healthy knee. 17,165 Prevalence of OA increases with concurrent meniscal injury resulting in a meniscectomy.…”

“…17,40 Many believe that BPTB grafts lead to increased prevalence of OA, 127,156 but incidence of OA after HG is equivalent. 43,185 Most alarmingly, is the increased prevalence of tibiofemoral OA after a second ACLR in the ipsilateral limb. 66 This suggests that athletes are a greater risk for developing post-traumatic OA, given how young most are at initial injury (<19 years old), therefore returning to high level sport and at increased risk of sustaining secondary injury.…”

“…43 Injuries to the lower extremity are most common in more fit and physically active individuals, 43 with injury risk increasing for high-level athletes. 9 Neuromuscular fatigue has been theorized a contributing factor associated with lower extremity musculoskeletal injury in athletes because injuries are most common at the end of games.…”

“…26 High level athletes have increased strength compared to recreational athletes, 31,64 and may require different sport-specific demands to evaluate fatigue-related biomechanical adaptations that may increase risk for injury in more fit athletes. 42,43 Therefore, the purpose of this study was to compare changes in running gait before and after generic exercise and sport-specific exercise between different fitness levels.…”