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The development of long‑term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction
Journal article   Peer reviewed

The development of long‑term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction

Susan Keays, Peter A Newcombe, Joanne Elizabeth Bullock-Saxton and Anthony C Keays
Archives of Orthopaedic and Trauma Surgery, Vol.143, pp.3201-3211
2023
DOI: https://doi.org/10.1007/s00402-022-04662-4
PMID: 36305965
url
https://doi.org/10.1007/s00402-022-04662-4View
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Abstract

Osteoarthritis Tibiofemoral Patellofemora Anterior cruciate ligament Reconstruction versus conservative Long-term
Purpose: The high incidence of osteoarthritis (OA) in relatively young sportspeople following anterior cruciate ligament (ACL) reconstruction is concerning. Surgery is considered to reduce the development of OA compared to conservative management. This long term study aimed to compare the incidence and severity of tibiofemoral OA (TFOA) and patellofemoral OA (PFOA) between reconstructed and non reconstructed treatment groups and to determine which factors influence the development of OA. Materials and methods Fifty six ACL reconstructed and 45 conservatively treated patients from a cohort of 330 were followed for 11 years (mean) post injury. Twenty nine patients had received a bone patellar tendon bone (B PT B) graft, and 27 had received a hamstring (semitendinosus or gracilis) tendon (HT) graft. Assessment included objective and subjective stability, quadriceps and hamstring strength and radiology. Chi square analyses compared OA between reconstructed and non reconstructed groups and between B PT B, HT and non surgical groups. Further analysis assessed the relationship between OA and age, time post injury, meniscal injury or meniscectomy, quadriceps strength, hamstring strength, objective and subjective stability and sporting activity. Results Forty eight per cent reconstructed and 53% non reconstructed patients developed TFOA (p = 0.690). Thirty six per cent reconstructed and 38% non reconstructed patients developed PFOA (p = 0.831) with moderate PFOA occurring only in the non reconstructed group. Close to significant differences (p = 0.075) were found comparing the severity of TFOA between groups with a higher incidence of moderate or severe OA in the non reconstructed and B PT B groups. TFOA differed significantly between the B PT B and HT groups. The development of OA was related to age, time post injury, meniscal injury or meniscectomy, quadriceps strength and subjective stability. Conclusions There were no significant differences in OA incidence between reconstructed and non reconstructed groups but fewer patients developed TFOA following HT grafting compared to B PT B grafting and to non surgical treatment. Quadriceps weakness and meniscal injuries or meniscectomy, both potentially modifiable, were strongly associated with the development of TF and PFOA.

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Surgery
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