Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy : Results from the KANON trial
(2019) In British journal of sports medicine 53(18). p.1168-1173- Abstract
Objectives: To evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy. Methods: 121 adults (ages 18-35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR... (More)
Objectives: To evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy. Methods: 121 adults (ages 18-35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR (n=58)) and as-treated groups (rehabilitation+early ACLR (n=59) vs rehabilitation +delayed ACLR (n=29) vs rehabilitation alone (n=29)). Results: Patellofemoral cartilage thickness decreased-58 μm (95% CI-104 to-11 μm) over 5 years post-ACL rupture, with the greatest loss observed in trochlea during the first 2 years. Participants randomised to rehabilitation+early ACLR had significantly greater loss of patellar cartilage thickness compared with participants randomised to rehabilitation+optional delayed ACLR over the first 2 years (-25 μm (-52, 1 μm) vs +14 μm (-6 to 34 μm), p=0.02) as well as over 5 years (-36 μm (-78 to 5 μm) vs +18 μm (-7, 42 μm), p=0.02). There were no statistically significant differences in patellofemoral cartilage thickness changes between as-treated groups. Conclusion: Patellofemoral (particularly trochlear) cartilage thickness loss was observed in young adults following acute ACL rupture. Early ACLR was associated with greater patellofemoral (particularly patellar) cartilage thickness loss over 5 years compared with optional delayed ACLR, indicating that early surgical intervention may be associated with greater short-term structural patellofemoral cartilage deterioration compared with optional delayed surgery. Trial registration number: ISRCTN84752559; Post-results.
(Less)
- author
- Culvenor, Adam G.
; Eckstein, Felix
; Wirth, Wolfgang
; Lohmander, L. Stefan
LU
and Frobell, Richard LU
- organization
- publishing date
- 2019-02-08
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- anterior cruciate ligament, cartilage, knee, patella, trochlea
- in
- British journal of sports medicine
- volume
- 53
- issue
- 18
- pages
- 1168 - 1173
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85061373363
- pmid:30737199
- ISSN
- 0306-3674
- DOI
- 10.1136/bjsports-2018-100167
- language
- English
- LU publication?
- yes
- id
- 1a9562b7-c4f9-4efc-b7d2-62e47e839159
- date added to LUP
- 2019-02-20 08:39:14
- date last changed
- 2024-07-23 09:55:20
@article{1a9562b7-c4f9-4efc-b7d2-62e47e839159, abstract = {{<p>Objectives: To evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy. Methods: 121 adults (ages 18-35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR (n=58)) and as-treated groups (rehabilitation+early ACLR (n=59) vs rehabilitation +delayed ACLR (n=29) vs rehabilitation alone (n=29)). Results: Patellofemoral cartilage thickness decreased-58 μm (95% CI-104 to-11 μm) over 5 years post-ACL rupture, with the greatest loss observed in trochlea during the first 2 years. Participants randomised to rehabilitation+early ACLR had significantly greater loss of patellar cartilage thickness compared with participants randomised to rehabilitation+optional delayed ACLR over the first 2 years (-25 μm (-52, 1 μm) vs +14 μm (-6 to 34 μm), p=0.02) as well as over 5 years (-36 μm (-78 to 5 μm) vs +18 μm (-7, 42 μm), p=0.02). There were no statistically significant differences in patellofemoral cartilage thickness changes between as-treated groups. Conclusion: Patellofemoral (particularly trochlear) cartilage thickness loss was observed in young adults following acute ACL rupture. Early ACLR was associated with greater patellofemoral (particularly patellar) cartilage thickness loss over 5 years compared with optional delayed ACLR, indicating that early surgical intervention may be associated with greater short-term structural patellofemoral cartilage deterioration compared with optional delayed surgery. Trial registration number: ISRCTN84752559; Post-results.</p>}}, author = {{Culvenor, Adam G. and Eckstein, Felix and Wirth, Wolfgang and Lohmander, L. Stefan and Frobell, Richard}}, issn = {{0306-3674}}, keywords = {{anterior cruciate ligament; cartilage; knee; patella; trochlea}}, language = {{eng}}, month = {{02}}, number = {{18}}, pages = {{1168--1173}}, publisher = {{BMJ Publishing Group}}, series = {{British journal of sports medicine}}, title = {{Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy : Results from the KANON trial}}, url = {{http://dx.doi.org/10.1136/bjsports-2018-100167}}, doi = {{10.1136/bjsports-2018-100167}}, volume = {{53}}, year = {{2019}}, }