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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-07-2020 | Osteoarthrosis | KNEE

Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction

Authors: Tomas Söderman, Marie-Louise Wretling, Mari Hänni, Christina Mikkelsen, Robert J. Johnson, Suzanne Werner, Anders Sundin, Adel Shalabi

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 7/2020

Abstract

Purpose

The aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development.

Methods

The cohort comprised 60 patients with a median follow-up 31 (range 28–33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test.

Results

Out of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft (p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment (p = 0.013) and the patellofemoral compartment (p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts (p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft (p = 0.0003) and similar results in those with intact graft (p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft (p < 0.0001).

Conclusions

Median 31 (range 28–33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts.

Level of evidence

Retrospective cohort study, Level III.

Ahlback S, Rydberg J (1980) X-ray classification and examination technics in gonarthrosis. Lakartidningen 77(2091–2093):2096

Andersson C, Odensten M, Gillquist J (1991) Knee function after surgical or nonsurgical treatment of acute rupture of the anterior cruciate ligament: a randomized study with a long-term follow-up period. Clin Orthop Relat Res 264:255–263

Arneja S, Leith J (2009) Review article: validity of the KT-1000 knee ligament arthrometer. J Orthop Surg (Hong Kong) 17:77–79

Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 20:767–777PubMed

Barrett AM, Craft JA, Replogle WH, Hydrick JM, Barrett GR (2011) Anterior cruciate ligament graft failure: a comparison of graft type based on age and Tegner activity level. Am J Sports Med 39:2194–2198PubMed

Bedi A, Maak T, Musahl V, Citak M, O'Loughlin PF, Choi D et al (2011) Effect of tibial tunnel position on stability of the knee after anterior cruciate ligament reconstruction: is the tibial tunnel position most important? Am J Sports Med 39:366–373PubMed

Bodkin SG, Werner BC, Slater LV, Hart JM (2019) Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05461-y CrossRefPubMed

Borchers JR, Pedroza A, Kaeding C (2009) Activity level and graft type as risk factors for anterior cruciate ligament graft failure: a case-control study. Am J Sports Med 37:2362–2367PubMed

Brostrom L, Eriksson E (1970) Operative Behandlung der inveterierten Kreuzbandschäden. (Operative treatment of old ruptures of the anterior cruciate ligament). In: Proceedings of the ninth international congress on ski traumatology and wintersportmedicine. Garmich Partenkirchen, West Germany, Nebel Verlag, pp 138–143

10.

Chaisson CE, Gale DR, Gale E, Kazis L, Skinner K, Felson DT (2000) Detecting radiographic knee osteoarthritis: what combination of views is optimal? Rheumatology (Oxford) 39:1218–1221

11.

Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22:632–644PubMed

12.

Daniel DM, Stone ML, Sachs R, Malcom L (1985) Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 13:401–407PubMed

13.

Eriksson E (1976) Reconstruction of the anterior cruciate ligament. Orthop Clin N Am 7:167–179

14.

Fithian DC, Paxton EW, Stone ML, Luetzow WF, Csintalan RP, Phelan D et al (2005) Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament-injured knee. Am J Sports Med 33:335–346PubMed

15.

Gomoll AH, Bach BR (2006) Managing tunnel malposition and widening in revision anterior cruciate ligament surgery. Oper Tech Sports Med 14:36–44

16.

Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234PubMed

17.

Hoffelner T, Resch H, Moroder P, Atzwanger J, Wiplinger M, Hitzl W et al (2012) No increased occurrence of osteoarthritis after anterior cruciate ligament reconstruction after isolated anterior cruciate ligament injury in athletes. Arthroscopy 28:517–525PubMed

18.

Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38:448–454PubMed

19.

Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6:107–114PubMed

20.

Johnson RJ, Eriksson E, Haggmark T, Pope MH (1984) Five- to ten-year follow-up evaluation after reconstruction of the anterior cruciate ligament. Clin Orthop Relat Res 183:122–140

21.

Jones HP, Appleyard RC, Mahajan S, Murrell GA (2003) Meniscal and chondral loss in the anterior cruciate ligament injured knee. Sports Med 33:1075–1089PubMed

22.

Keays SL, Newcombe PA, Bullock-Saxton JE, Bullock MI, Keays AC (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. Am J Sports Med 38:455–463PubMed

23.

Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502PubMedPubMedCentral

24.

Kessler MA, Behrend H, Henz S, Stutz G, Rukavina A, Kuster MS (2008) Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc 16:442–448PubMed

25.

Li RT, Lorenz S, Xu Y, Harner CD, Fu FH, Irrgang JJ (2011) Predictors of radiographic knee osteoarthritis after anterior cruciate ligament reconstruction. Am J Sports Med 39:2595–2603PubMed

26.

Liu SH, Osti L, Henry M, Bocchi L (1995) The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Jt Surg Br 77:586–588

27.

Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152PubMed

28.

Meunier A, Odensten M, Good L (2007) Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up. Scand J Med Sci Sports 17:230–237PubMed

29.

Natri A, Jarvinen M, Lehto M, Kannus P (1996) Reconstruction of the chronically insufficient anterior cruciate ligament: long term results of the Eriksson procedure. Int Orthop 20:28–31PubMed

30.

Neuman P, Englund M, Kostogiannis I, Friden T, Roos H, Dahlberg LE (2008) Prevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med 36:1717–1725PubMed

31.

Nordenvall R, Bahmanyar S, Adami J, Stenros C, Wredmark T, Fellander-Tsai L (2012) A population-based nationwide study of anterior cruciate ligament injury in Sweden, 2001–2009: incidence, treatment, and sex differences. Am J Sports Med 40:1808–1813PubMed

32.

Oiestad BE, Engebretsen L, Storheim K, Risberg MA (2009) Knee osteoarthritis after anterior cruciate ligament injury: a systematic review. Am J Sports Med 37:1434–1443PubMed

33.

Oiestad BE, Holm I, Aune AK, Gunderson R, Myklebust G, Engebretsen L et al (2010) Knee function and prevalence of knee osteoarthritis after anterior cruciate ligament reconstruction: a prospective study with 10 to 15 years of follow-up. Am J Sports Med 38:2201–2210PubMed

34.

Oiestad BE, Holm I, Engebretsen L, Risberg MA (2011) The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10–15 years after anterior cruciate ligament reconstruction. Br J Sports Med 45:583–588PubMed

35.

Rangger C, Daniel DM, Stone ML, Kaufman K (1993) Diagnosis of an ACL disruption with KT-1000 arthrometer measurements. Knee Surg Sports Traumatol Arthrosc 1:60–66PubMed

36.

Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W et al (2008) Non-contact ACL injuries in female athletes: an International Olympic Committee current concepts statement. Br J Sports Med 42:394–412PubMedPubMedCentral

37.

Rothman KJ (1990) No adjustments are needed for multiple comparisons. Epidemiology 1:43–46PubMed

38.

Sanders TL, Pareek A, Hewett TE, Levy BA, Dahm DL, Stuart MJ et al (2017) Long-term rate of graft failure after ACL reconstruction: a geographic population cohort analysis. Knee Surg Sports Traumatol Arthrosc 25:222–228PubMed

39.

Schiphof D, Boers M, Bierma-Zeinstra SM (2008) Differences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Ann Rheum Dis 67:1034–1036PubMed

40.

Schlumberger M, Schuster P, Schulz M, Immendorfer M, Mayer P, Bartholoma J et al (2017) Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases. Knee Surg Sports Traumatol Arthrosc 25:1535–1541PubMed

41.

Stein V, Li L, Lo G, Guermazi A, Zhang Y, Kent Kwoh C et al (2012) Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears. Rheumatol Int 32:1197–1208PubMed

42.

Steiner ME, Brown C, Zarins B, Brownstein B, Koval PS, Stone P (1990) Measurement of anterior-posterior displacement of the knee. A comparison of the results with instrumented devices and with clinical examination. J Bone Jt Surg Am 72:1307–1315

43.

Wipfler B, Donner S, Zechmann CM, Springer J (2011) Anterior cruciate ligament reconstruction using patellar tendon versus hamstring tendon: a prospective comparative study with 9-year follow-up. Arthroscopy 27:653–665PubMed

44.

Wroble RR, Van Ginkel LA, Grood ES, Noyes FR, Shaffer BL (1990) Repeatability of the KT-1000 arthrometer in a normal population. Am J Sports Med 18:396–399PubMed

Title: Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction
Authors: Tomas Söderman
Marie-Louise Wretling
Mari Hänni
Christina Mikkelsen
Robert J. Johnson
Suzanne Werner
Anders Sundin
Adel Shalabi
Publication date: 01-07-2020
Publisher: Springer Berlin Heidelberg
Keywords: Osteoarthrosis
Magnetic Resonance Imaging
Magnetic Resonance Imaging
Osteoarthrosis
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 7/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-019-05726-6

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Springer Medicine

Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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