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Prevalence of Tibiofemoral Osteoarthritis 15 Years After Nonoperative Treatment of Anterior Cruciate Ligament Injury: A Prospective Cohort Study.

Neuman, Paul LU ; Englund, Martin LU ; Kostogiannis, Ioannis LU ; Fridén, Thomas LU ; Roos, Harald LU and Dahlberg, Leif LU (2008) In American Journal of Sports Medicine 36(9). p.1717-1725
Abstract
BACKGROUND: The occurrence of osteoarthritis (OA), associated meniscal injuries, meniscectomy, and patient-related measures for patients treated nonoperatively after anterior cruciate ligament (ACL) injuries have not been well described in the literature in terms of natural history. HYPOTHESIS: Patients with ACL injury can achieve a low occurrence of tibiofemoral OA and good knee function when treated without ACL reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute, complete ACL injury were observed for 15 years. All patients were primarily treated with activity modification and without ACL reconstruction. To achieve improved functional stability, supervised... (More)
BACKGROUND: The occurrence of osteoarthritis (OA), associated meniscal injuries, meniscectomy, and patient-related measures for patients treated nonoperatively after anterior cruciate ligament (ACL) injuries have not been well described in the literature in terms of natural history. HYPOTHESIS: Patients with ACL injury can achieve a low occurrence of tibiofemoral OA and good knee function when treated without ACL reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute, complete ACL injury were observed for 15 years. All patients were primarily treated with activity modification and without ACL reconstruction. To achieve improved functional stability, supervised physical therapy was initiated early after injury. The patients were examined using anteroposterior weightbearing radiography. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee-related symptoms and knee function. RESULTS: Seventy-nine patients consented to radiographic examination and 93 completed the KOOS questionnaire. Thirteen patients (16%), all of whom were among the 35 patients whose knees were meniscectomized, developed radiographic tibiofemoral OA. In contrast, none of the remaining nonmeniscectomized and radiographed knees developed OA (n = 44) (P < .0001). Sixty-three patients (68%) had an asymptomatic knee. Twenty-two patients (23%) had undergone ACL reconstruction with a mean time of 4 years after injury. CONCLUSION: The study had a favorable long-term outcome regarding incidence of radiographic knee OA, knee function and symptoms, and need for ACL reconstruction. Although risk factors for posttraumatic OA are multifactorial, the primary risk factor that stood out in this study was if a meniscectomy had been performed. Early activity modification and neuromuscular knee rehabilitation might also have been related to the low prevalence of radiographic knee OA. In patients with ACL injury willing to moderate activity level to avoid reinjury, initial treatment without ACL reconstruction should be considered. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
long-term follow-up, treatment, nonoperative, anterior cruciate ligament (ACL), osteoarthritis (OA)
in
American Journal of Sports Medicine
volume
36
issue
9
pages
1717 - 1725
publisher
American Orthopaedic Society for Sports Medicine
external identifiers
  • wos:000258719700006
  • pmid:18483197
  • scopus:46849088407
ISSN
1552-3365
DOI
10.1177/0363546508316770
language
English
LU publication?
yes
id
ccfd6c5a-ecb0-4825-96ff-cf1894ea57e6 (old id 1154085)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18483197?dopt=Abstract
date added to LUP
2008-06-05 09:14:28
date last changed
2017-11-19 04:01:19
@article{ccfd6c5a-ecb0-4825-96ff-cf1894ea57e6,
  abstract     = {BACKGROUND: The occurrence of osteoarthritis (OA), associated meniscal injuries, meniscectomy, and patient-related measures for patients treated nonoperatively after anterior cruciate ligament (ACL) injuries have not been well described in the literature in terms of natural history. HYPOTHESIS: Patients with ACL injury can achieve a low occurrence of tibiofemoral OA and good knee function when treated without ACL reconstruction. STUDY DESIGN: Cohort study (prognosis); Level of evidence, 2. METHODS: One hundred consecutive patients with an acute, complete ACL injury were observed for 15 years. All patients were primarily treated with activity modification and without ACL reconstruction. To achieve improved functional stability, supervised physical therapy was initiated early after injury. The patients were examined using anteroposterior weightbearing radiography. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee-related symptoms and knee function. RESULTS: Seventy-nine patients consented to radiographic examination and 93 completed the KOOS questionnaire. Thirteen patients (16%), all of whom were among the 35 patients whose knees were meniscectomized, developed radiographic tibiofemoral OA. In contrast, none of the remaining nonmeniscectomized and radiographed knees developed OA (n = 44) (P &lt; .0001). Sixty-three patients (68%) had an asymptomatic knee. Twenty-two patients (23%) had undergone ACL reconstruction with a mean time of 4 years after injury. CONCLUSION: The study had a favorable long-term outcome regarding incidence of radiographic knee OA, knee function and symptoms, and need for ACL reconstruction. Although risk factors for posttraumatic OA are multifactorial, the primary risk factor that stood out in this study was if a meniscectomy had been performed. Early activity modification and neuromuscular knee rehabilitation might also have been related to the low prevalence of radiographic knee OA. In patients with ACL injury willing to moderate activity level to avoid reinjury, initial treatment without ACL reconstruction should be considered.},
  author       = {Neuman, Paul and Englund, Martin and Kostogiannis, Ioannis and Fridén, Thomas and Roos, Harald and Dahlberg, Leif},
  issn         = {1552-3365},
  keyword      = {long-term follow-up,treatment,nonoperative,anterior cruciate ligament (ACL),osteoarthritis (OA)},
  language     = {eng},
  number       = {9},
  pages        = {1717--1725},
  publisher    = {American Orthopaedic Society for Sports Medicine},
  series       = {American Journal of Sports Medicine},
  title        = {Prevalence of Tibiofemoral Osteoarthritis 15 Years After Nonoperative Treatment of Anterior Cruciate Ligament Injury: A Prospective Cohort Study.},
  url          = {http://dx.doi.org/10.1177/0363546508316770},
  volume       = {36},
  year         = {2008},
}