The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

Abstract

Anterior cruciate ligament (ACL) tears are a common injury, particularly in the athletic and youth populations. The known association between ACL injury and subsequent osteoarthritis (OA) of the knee merits a more in-depth understanding of the relationship between the ACL-injured knee and osteoarthritis. ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of osteoarthritis. ACL insufficiency results in deterioration of the normal physiologic knee bending culminating in increased anterior tibial translation and increased internal tibial rotation. This leads to increased mean contact stresses in the posterior medial and lateral compartments under anterior and rotational loading. However, surgical reconstruction of the ACL has not been shown to reduce the risk of future OA development back to baseline and has variability based on operative factors of graft choice, timing of surgery, presence of meniscal and chondral abnormalities, and surgical technique. Known strategies to prevent OA development are applicable to patients with ACL deficiency or after ACL reconstruction and include weight management, avoidance of excessive musculoskeletal loading, and strength training. Reconstruction of the ACL does not necessarily prevent osteoarthritis in many of these patients and may depend on several external variables.

History of previous knee surgery does not affect the clinical outcomes of primary total knee arthroplasty in an Asian population

“…For example, in ACL injuries, concomitant meniscal or chondral injuries, post-operative excessive musculoskeletal loading, high BMI and inadequate strength training can all result in early osteoarthritis (19)(20)(21). In our study, patients who underwent previous knee surgery had no reported complications necessitating re-operation or revision surgeries on their follow-up visits (longest follow-up being up to 8 years after TKA).…”

Anterior Cruciate Ligament Insufficiency: Delay in Surgery and Its Association with Spectrum of Intraarticular Knee Lesions

“…Lateral tibial condylar lesions were associated with RR=3.264(95% CI of 1.253 -8.503).. Chondral lesions of patella(14.2%), Trochlea (4.7%)& Lateral femoral condyle( 5.7%) though present, didn't have significant association with delay in surgery. Our observations in 106 patients have limitations in throwing light to association of chondral changes in patella, trochlea and lateral femoral condyle, as compared to some investigators 4,[25][26][27][28] , as the numbers in subtypes were minimal for statistical association. Delay in surgery was also found to have significant association with the presence of intraarticular knee lesions and their number (<3lesions />3 lesions) RR 1.177(CI 1,027-1.349),P-.02 .…”

“…Despite a 'typical' mechanism of injury leading to ACL rupture [6][7][8] , poor rate of initial diagnosis, delay in surgery & its consequences are extremely common [9][10][11] . Concurrent Meniscal and Chondral Injuries in ACL injured knees has been reported by many authors [12][13][14][15][16][17][18][19][20][21] and remains a major cause of concern and prognostic factor in long term results [3][4][5] . Many studies have tried to associate delay in surgery to chondral & meniscal lesions necessitating additional procedures during ACL reconstruction surgery.…”

Effectiveness of Accelerated Rehabilitation for Arthroscopic Anterior Cruciate Ligament (ACL) Reconstruction in Football Players

“…ACL injury, especially with concomitant meniscal or other ligamentous pathology, predisposes the knee to an increased risk of OA. Alone ACL reconstruction has not been shown to reduce the risk of future OA; weight management, avoidance of excessive musculoskeletal loading and strength training are further important strategies [5].…”