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Treatment and outcome of anterior cruciate ligament injury: Truth or Consequences

Frobell, Richard LU (2007) In Lund University Faculty of Medicine Doctoral Dissertation Series 2007:163
Abstract
The overall aim of the work presented in this thesis was to evaluate the incidence, outcome and consequences within the 1st year of acute ACL injury of the knee.

The KANON-study, a randomized controlled clinical trial comparing surgical and non-surgical treatment after acute ACL injury, was initiated and some results are included in this thesis. 642 subjects with acute knee injury were assessed in order to include 121 subjects in this RCT. Subgroups of the subjects assessed in the KANON-study and a group of amateur soccer players (188) were assessed.

The annual incidence of ACL injury was found to be 81 per 100 000 inhabitants aged 10-64 years. Possibly as many as 50% of those with an acute ACL tear are misdiagnosed at... (More)
The overall aim of the work presented in this thesis was to evaluate the incidence, outcome and consequences within the 1st year of acute ACL injury of the knee.

The KANON-study, a randomized controlled clinical trial comparing surgical and non-surgical treatment after acute ACL injury, was initiated and some results are included in this thesis. 642 subjects with acute knee injury were assessed in order to include 121 subjects in this RCT. Subgroups of the subjects assessed in the KANON-study and a group of amateur soccer players (188) were assessed.

The annual incidence of ACL injury was found to be 81 per 100 000 inhabitants aged 10-64 years. Possibly as many as 50% of those with an acute ACL tear are misdiagnosed at the clinical examination in the acute phase.

More than every second (57%) acutely ACL injured knee had an associated cortical bone depression fracture and almost all had bone marrow lesions (BML) visualized on MRI. A strong independent relationship between cortical bone depression fractures and bone marrow lesion volumes (p<0.001) suggests that a high proportion of ACL injured knees suffer from extensive compressive trauma to the joint cartilage which may, in part, explain the high frequency of osteoarthritis following this injury.

In amateur soccer players, older age, female gender and lower level of competition (division) were associated with worse self-reported physical activity level. Thus, we recommend a clear description of how activity level was administered as well as adjustment for these variables in reports using self-reported activity level as an outcome.

Using state-of-the-art quantitative MRI technology, we assessed the first year development of joint fluid (JF), BML and cartilage morphometry. JF and BML volumes gradually decreased over the first year, although BML was still persistent in 62% of the knees after one year. One year after the ACL injury, a consistent reduction of cartilage volume, cartilage surface area and thickness was found in the trochlea femur, while an increase of cartilage volume and surface area was found in the central medial femur. Surgical ACL reconstruction was directly and significantly related to increased JF volume at 3 and 6 months, BML volume at 6 months, cartilage volume and area in central medial femur, and decreased cartilage surface area in trochlea femur at 1 year after injury. (Less)
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author
supervisor
opponent
  • Professor Engebretsen, Lars, Ullevaal University Hospital, Oslo Sports Trauma Research Center, Norway
organization
publishing date
type
Thesis
publication status
published
subject
keywords
magnetic resonance imaging, Knee injuries, treatment, anterior cruciate ligament, outcome
in
Lund University Faculty of Medicine Doctoral Dissertation Series 2007:163
pages
114 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Konference room BMC (D-house), 15th floor, Lund University Hospital
defense date
2007-12-14 13:15
ISSN
1652-8220
ISBN
978-91-85897-41-4
project
KANON-study
language
English
LU publication?
yes
id
82d4e5f9-dfa0-45f9-83ae-c608dc90a5be (old id 610337)
date added to LUP
2007-11-20 14:12:24
date last changed
2016-09-19 08:44:52
@phdthesis{82d4e5f9-dfa0-45f9-83ae-c608dc90a5be,
  abstract     = {The overall aim of the work presented in this thesis was to evaluate the incidence, outcome and consequences within the 1st year of acute ACL injury of the knee.<br/><br>
The KANON-study, a randomized controlled clinical trial comparing surgical and non-surgical treatment after acute ACL injury, was initiated and some results are included in this thesis. 642 subjects with acute knee injury were assessed in order to include 121 subjects in this RCT. Subgroups of the subjects assessed in the KANON-study and a group of amateur soccer players (188) were assessed.<br/><br>
The annual incidence of ACL injury was found to be 81 per 100 000 inhabitants aged 10-64 years. Possibly as many as 50% of those with an acute ACL tear are misdiagnosed at the clinical examination in the acute phase. <br/><br>
More than every second (57%) acutely ACL injured knee had an associated cortical bone depression fracture and almost all had bone marrow lesions (BML) visualized on MRI. A strong independent relationship between cortical bone depression fractures and bone marrow lesion volumes (p&lt;0.001) suggests that a high proportion of ACL injured knees suffer from extensive compressive trauma to the joint cartilage which may, in part, explain the high frequency of osteoarthritis following this injury.<br/><br>
In amateur soccer players, older age, female gender and lower level of competition (division) were associated with worse self-reported physical activity level. Thus, we recommend a clear description of how activity level was administered as well as adjustment for these variables in reports using self-reported activity level as an outcome.<br/><br>
Using state-of-the-art quantitative MRI technology, we assessed the first year development of joint fluid (JF), BML and cartilage morphometry. JF and BML volumes gradually decreased over the first year, although BML was still persistent in 62% of the knees after one year. One year after the ACL injury, a consistent reduction of cartilage volume, cartilage surface area and thickness was found in the trochlea femur, while an increase of cartilage volume and surface area was found in the central medial femur. Surgical ACL reconstruction was directly and significantly related to increased JF volume at 3 and 6 months, BML volume at 6 months, cartilage volume and area in central medial femur, and decreased cartilage surface area in trochlea femur at 1 year after injury.},
  author       = {Frobell, Richard},
  isbn         = {978-91-85897-41-4},
  issn         = {1652-8220},
  keyword      = {magnetic resonance imaging,Knee injuries,treatment,anterior cruciate ligament,outcome},
  language     = {eng},
  pages        = {114},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University Faculty of Medicine Doctoral Dissertation Series 2007:163},
  title        = {Treatment and outcome of anterior cruciate ligament injury: Truth or Consequences},
  year         = {2007},
}