The protective effect of anterior cruciate ligament reconstruction on articular cartilage: a systematic review of animal studies

Deckers, Claudia; Stephan, Patrick; Wever, Kimberley E.; Hooijmans, Carlijn R.; Hannink, Gerjon

doi:10.1016/j.joca.2018.10.001

Cited by 6 publications

(7 citation statements)

References 72 publications

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“… 31 Early cartilage degeneration assessed using MRI has also been shown to be more pronounced after ACLR than after rehabilitation alone in some studies, 54 while no differences have been found in others. 58 Our study, along with studies with longer-term follow-ups 2 , 31 , 40 and animal studies, 7 reinforces the conclusion that reconstruction does not protect the ACL-injured knee from OA. Hence, rehabilitation alone does not provide inferior long-term outcomes compared with ACLR and is a viable solution for some patients.…”

Section: Discussionsupporting

confidence: 76%

Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study

Pedersen

Grindem

Berg

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices. Purpose: To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (<6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (>6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone. Study Design: Cohort study; Level of evidence, 2. Methods: We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&L grade ≥2 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain ≤72. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&L grade ≥2/osteophyte (definite osteophyte without joint space narrowing) and K&L grade ≥1. Results: At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&L grade ≥2) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&L grade ≥2/osteophyte and K&L grade ≥1, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups. Conclusion: There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.

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Section: Discussionsupporting

confidence: 76%

Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study

Pedersen

Grindem

Berg

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…Most studies in dogs with HA have been carried out in the surgically (anterior cruciate ligament transection, ACLT)-induced OA model. ACLT produces metabolic, biochemical, biomechanical and morphological changes in articular cartilage of the unstable knee that are consistent with those of OA in humans (225–231). Following ACLT, OA is often characterized by marginal osteophytes, fibrillation, cartilage PG depletion, synovial inflammation, and joint effusion (232).…”

Section: Pharmacotherapeutics Of Hamentioning

confidence: 68%

Hyaluronic Acid: Molecular Mechanisms and Therapeutic Trajectory

Gupta

Lall²,

Srivastava³

et al. 2019

Front. Vet. Sci.

481

345

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Hyaluronic acid (also known as hyaluronan or hyaluronate) is naturally found in many tissues and fluids, but more abundantly in articular cartilage and synovial fluid (SF). Hyaluronic acid (HA) content varies widely in different joints and species. HA is a non-sulfated, naturally occurring non-protein glycosaminoglycan (GAG), with distinct physico-chemical properties, produced by synoviocytes, fibroblasts, and chondrocytes. HA has an important role in the biomechanics of normal SF, where it is partially responsible for lubrication and viscoelasticity of the SF. The concentration of HA and its molecular weight (MW) decline as osteoarthritis (OA) progresses with aging. For that reason, HA has been used for more than four decades in the treatment of OA in dogs, horses and humans. HA produces anti-arthritic effects via multiple mechanisms involving receptors, enzymes and other metabolic pathways. HA is also used in the treatment of ophthalmic, dermal, burns, wound repair, and other health conditions. The MW of HA appears to play a critical role in the formulation of the products used in the treatment of diseases. This review provides a mechanism-based rationale for the use of HA in some disease conditions with special reference to OA.

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“…Some studies even suggested a worse OA long-term prognosis for operated ACL-deficient knees compared to knees treated conservatively [5]. Experimental studies in animals demonstrated that ACL reconstruction did not protect cartilages from degenerative changes [62]. Explanative hypotheses rely on the fact that ACL reconstructive surgery does not restore normal joint mechanics and may induce prolonged joint inflammation deleterious to tissues healing, or that damages caused to the joint tissue are not readily reversible through joint stabilization [2].…”

Section: Discussionmentioning

confidence: 99%

Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model

et al. 2022

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Background Anterior cruciate ligament (ACL) repair techniques are new emerging strategies prevailing, in selected cases, over standard reconstruction of the ACL with excision of its remnants. Mid-substance ACL tears represent a challenge for ACL repair techniques, and remnants-preserving ACL reconstruction (rp-ACLR) using an autograft remains the recommended treatment in this situation. However, morbidity associated with the autograft harvesting prompts the need for alternative surgical strategies based on the use of synthetic scaffolds. Relevant small animal models of mid-substance tears with ACL remnants preservation and reconstruction are necessary to establish the preliminary proof of concept of these new strategies. Methods A rat model of rp-ACLR using a tendinous autograft after complete mid-substance ACL transection was established. Twelve weeks following surgery, clinical outcomes and knee joints were assessed through visual gait analysis, Lachman tests, thigh perimeter measurements, magnetic resonance imaging, micro-computed tomography, and histology, to evaluate the morbidity of the procedure, accuracy of bone tunnel positioning, ACL remnants fate, osteoarthritis, and autograft bony integration. Results were compared with those obtained with isolated ACL transection without reconstruction and to right non-operated knees. Results and discussion Most operated animals were weight-bearing the day following surgery, and no adverse inflammatory reaction has been observed for the whole duration of the study. Autograft fixation with cortical screws provided effective graft anchorage until sacrifice. Healing of the transected ACL was not observed in the animals in which no graft reconstruction was performed. rp-ACLR was associated with a reduced degeneration of the ACL remnants (p = 0.004) and cartilages (p = 0.0437). Joint effusion and synovitis were significantly lower in the reconstructed group compared to the transected ACL group (p = 0.004). Most of the bone tunnel apertures were anatomically positioned in the coronal and/or sagittal plane. The most deviated bone tunnel apertures were the tibial ones, located in median less than 1 mm posteriorly to anatomical ACL footprint center. Conclusion This study presents a cost-effective, new relevant and objective rat model associated with low morbidity for the preliminary study of bio-implantable materials designed for remnants-preserving ACL surgery after mid-substance ACL tear.

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The protective effect of anterior cruciate ligament reconstruction on articular cartilage: a systematic review of animal studies

Cited by 6 publications

References 72 publications

Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study

Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study

Hyaluronic Acid: Molecular Mechanisms and Therapeutic Trajectory

Remnants-preserving ACL reconstruction using direct tendinous graft fixation: a new rat model

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