Prevalence and Predictors of Patellofemoral Osteoarthritis after Anterior Cruciate Ligament Reconstruction with Hamstring Tendon Autograft

Abstract

BackgroundThe present study aimed to evaluate the prevalence of patellofemoral osteoarthritis (PFOA) and identify the factors that affect PFOA development after single-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. We hypothesized that detecting these factors could be helpful in establishment of a rehabilitation strategy to focus on the modifiable factors.MethodsOf the 324 patients who underwent primary ACL reconstruction between January 2010 and June 2013, 92 patients who were available for follow-up for a minimum of 36 months after the surgery and underwent second-look arthroscopy were enrolled. Subjective assessments and clinical outcome evaluation were conducted. Arthroscopic cartilage evaluation was done using the Outerbridge classification. Univariable and multivariable logistic regression analyses were used.ResultsNinety-two patients were evaluated at an average of 38.9 ± 5.4 months of follow-up. PFOA above grade 2 was observed in 19 patients (20.7%) at the second-look arthroscopy. Of them, three patients with pre-existing PFOA (3.3%) showed progression of the Outerbridge grade, and 16 (17.4%) had newly developed PFOA. According to the multivariable logistic regression analysis, isokinetic extensor deficit at 60°/sec at the last follow-up (odds ratio [OR], 2.193; 95% confidence interval [CI], 1.081 to 12.439; p = 0.031), age at primary surgery (OR, 1.118; 95% CI, 1.019 to 1.227; p = 0.018), and concurrent meniscectomy at primary surgery (OR, 0.091; 95% CI, 1.012 to 1.177; p = 0.023) were the significant predictors of PFOA development.ConclusionsSignificant predictors of PFOA after ACL reconstruction with hamstring autograft were decreased quadriceps strength at last follow-up, increased age, and concurrent meniscectomy at primary surgery. Quadriceps weakness as a modifiable factor should be considered in the establishment of a rehabilitation strategy to prevent PFOA after ACL reconstruction, especially in older age.

Patient-Reported Outcomes and Knee Mechanics Correlate With Patellofemoral Deep Cartilage UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction

“…PFOA after ACLR is thought to arise, in part, because of the increased external rotation of the tibia 44,57 and decreased quadriceps strength 28 that alter the alignment and tracking of the patella in the trochlear groove. 12,53 External rotation of the tibia relative to the femur induces a rotational force on the patellar tendon 29 that, when combined with reduced dynamic stabilization from the weakened quadriceps complex, causes the patella to tilt and track more laterally during knee flexion, 53 subjecting patellofemoral cartilage to potentially damaging stresses.…”

Does patellar alignment or trochlear morphology predict worsening of patellofemoral disease within the first 5 years after anterior cruciate ligament reconstruction?

“…Importantly, patellar alignment may be modifiable [22,37] and may therefore represent a promising target following ACLR for optimizing both structural and symptom outcomes. Alignment and morphology could be evaluated alongside other known risk factors for posttraumatic patellofemoral OA [8,31,34,38,39] to inform clinical decision making. The results of our study warrant further research to determine whether mechanistic factors contributing to patellofemoral OA can be effectively addressed in ACLR rehabilitation.…”

“…Despite patient perspectives [3], the increased risk of developing knee OA following ACL injury is not mitigated by surgical reconstruction (ACLR) [4][5][6]. Although typically considered a disease of the tibiofemoral joint, OA following ACLR occurs frequently in the patellofemoral joint [5,[7][8][9] with a median prevalence of nearly 50% 10-15 years post-ACLR [10]. Patellofemoral OA following ACLR is associated with pain [9].…”

The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction

“…Although prior studies have investigated risk factors for long-term adverse events following ACLR, [20][21][22] this study was the first effort to identify predictors of 30-day postoperative complications. Patient history of severe chronic obstructive pulmonary disease was the only independent risk factor associated with both minor and overall complications.…”