Purpose: Several studies1,2have highlighted the high incidence ofpremature osteoarthritis (OA) in relatively young sportspeople follow-ing anterior cruciate ligament (ACL) surgery. Fewer studies3haveassessed the incidence of OA following non-surgically treated ACLpatients and to date no study was found that assessed OA in anuninjured control group. This study aimed to assess the incidence oftibiofemoral OA (TFOA) and patellofemoral OA (PFOA) in non-surgically treated ACL injured group and compare this to an uninjuredcontrol group matched for age and activity level. A secondary aim wasto assess the factors inﬂuencing OA in the injured group.Method: A cohort of 56 ACL injured patients were treated withoutsurgery and followed over the long-term. Twenty-ﬁve patients, aged to46 years old, were selected from the cohort and matched for age andsporting history with 25 uninjured athletes in order to compare theincidence of OA in ACL injured and uninjured age-matched athletes.The injured group comprised 6 females and 19 males aged 23 to 46years old (mean 32). The uninjured group comprised 9 females and 16males aged 21 to 44 years old (mean 34). The patients were assessedfor clinical and instrumented stability and radiology using 4 x-ray views.Assessment of presence of OA by 2 assessors was based on theKelgren-Lawrence scale. The anterior-posterior views were taken inweight-bearing and the intercondylar views were completed asdescribed by Le Prade. A discriminant analysis was conducted toassess which factors inﬂuenced the development of OA.Results: 52% of the injured patients had TFOA (32% mild, 20%moderate) and 32% had PFOA (all mild). In contrast, only one unin-jured sportsperson (4%) had OA, mild TFOA. A discriminant analysis(n = 56) found that 4 factors reliably discriminated between thosepatients who did and did not develop OA following ACL injury namely,meniscal injury (p < .001); left-sided injury (p < .014); older age atinjury (29 v 25 years, p = 0.007) and time post-injury (15.7 years v 9.5years, p = 0.004), χ2(7, n = 56) = 49.93; p < .001. Conclusions: The incidence of premature OA following ACL injuriestreated conservatively is disturbingly high especially in comparison touninjured aged matched individuals active in sport. The incidence andseverity of OA is as high as that reported following ACL reconstruction.4The development of OA following ACL injury was inﬂuenced bymeniscal injury, older age at the time of injury, time post injury and leftsided injury..
2015 Royal Australian College of Radiologists' (RANZCR) Annual Scientific Meeting, Adelaide, Australia 29 October - 1 November 2015
Journal of Medical Imaging and Radiation Oncology / Vol. 59, Supplement 1, pp.102