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Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy : Results from the KANON trial

Culvenor, Adam G.; Eckstein, Felix; Wirth, Wolfgang; Lohmander, L. Stefan LU and Frobell, Richard LU (2019) In British journal of sports medicine
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.

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author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
anterior cruciate ligament, cartilage, knee, patella, trochlea
in
British journal of sports medicine
publisher
BMJ Publishing Group
external identifiers
  • scopus:85061373363
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
2019-03-19 04:05:46
@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 (&lt;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},
  keyword      = {anterior cruciate ligament,cartilage,knee,patella,trochlea},
  language     = {eng},
  month        = {02},
  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},
  year         = {2019},
}