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Early anterior cruciate ligament reconstruction does not affect 5 year change in knee cartilage thickness : secondary analysis of a randomized clinical trial

Wirth, W. ; Eckstein, F. ; Culvenor, A. G. ; Hudelmaier, M. I. ; Stefan Lohmander, L. LU and Frobell, R. B. LU (2021) In Osteoarthritis and Cartilage 29(4). p.518-526
Abstract

Objective: To compare 5-year change in femorotibial cartilage thickness in 121 young, active adults with an acute anterior cruciate ligament (ACL) tear randomized to a strategy of structured rehabilitation plus early ACL reconstruction (ACLR) or structured rehabilitation plus optional delayed ACLR. Design: 62 patients were randomized to early ACLR, 59 to optional delayed ACLR. Magnetic resonance imaging (MRI) was acquired within 4 weeks of injury, at two- and 5-years follow-up. Main outcome was 5-year change in overall femorotibial cartilage thickness. Secondary outcomes included the location-independent cartilage ChangeScore, summarizing thinning and thickening in 16 femorotibial subregions. An exploratory as-treated comparison was... (More)

Objective: To compare 5-year change in femorotibial cartilage thickness in 121 young, active adults with an acute anterior cruciate ligament (ACL) tear randomized to a strategy of structured rehabilitation plus early ACL reconstruction (ACLR) or structured rehabilitation plus optional delayed ACLR. Design: 62 patients were randomized to early ACLR, 59 to optional delayed ACLR. Magnetic resonance imaging (MRI) was acquired within 4 weeks of injury, at two- and 5-years follow-up. Main outcome was 5-year change in overall femorotibial cartilage thickness. Secondary outcomes included the location-independent cartilage ChangeScore, summarizing thinning and thickening in 16 femorotibial subregions. An exploratory as-treated comparison was performed additionally. Results: Baseline and at least one follow-up MRI were available for 117 patients. Over 5 years, a comparable increase in overall femorotibial cartilage thickness was observed for patients randomized to early ACLR (n = 59) and patients randomized to optional delayed ACLR (n = 58, adjusted mean difference: −5 μm, 95% CI: [−118, 108]μm). However, the location-independent cartilage ChangeScore was greater in those treated with early ACLR than in patients treated with optional delayed ACLR (adjusted mean difference: 403 μm [119, 687]μm). As-treated analysis showed no between-group differences for the main outcome, while the location-independent cartilage ChangeScore was greater for patients treated with early (adjusted mean difference: 632 μm [268, 996]μm) or delayed ACLR (adjusted mean difference: 449 μm [108, 791]μm) than for patients treated with rehabilitation alone. Conclusions: In young active adults with acute ACL-injury, choice of treatment strategy for the injured ACL did not modify the magnitude of 5-year change in overall femorotibial cartilage thickness. Trial registration: ISRCTN84752559.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anterior cruciate ligament, Cartilage, Knee, MRI, Osteoarthritis
in
Osteoarthritis and Cartilage
volume
29
issue
4
pages
9 pages
publisher
Elsevier
external identifiers
  • pmid:33549723
  • scopus:85103487255
ISSN
1063-4584
DOI
10.1016/j.joca.2021.01.004
language
English
LU publication?
yes
id
7b8b376e-9ed2-4722-99f8-287656a74e51
date added to LUP
2021-04-14 10:34:46
date last changed
2021-06-08 06:08:23
@article{7b8b376e-9ed2-4722-99f8-287656a74e51,
  abstract     = {<p>Objective: To compare 5-year change in femorotibial cartilage thickness in 121 young, active adults with an acute anterior cruciate ligament (ACL) tear randomized to a strategy of structured rehabilitation plus early ACL reconstruction (ACLR) or structured rehabilitation plus optional delayed ACLR. Design: 62 patients were randomized to early ACLR, 59 to optional delayed ACLR. Magnetic resonance imaging (MRI) was acquired within 4 weeks of injury, at two- and 5-years follow-up. Main outcome was 5-year change in overall femorotibial cartilage thickness. Secondary outcomes included the location-independent cartilage ChangeScore, summarizing thinning and thickening in 16 femorotibial subregions. An exploratory as-treated comparison was performed additionally. Results: Baseline and at least one follow-up MRI were available for 117 patients. Over 5 years, a comparable increase in overall femorotibial cartilage thickness was observed for patients randomized to early ACLR (n = 59) and patients randomized to optional delayed ACLR (n = 58, adjusted mean difference: −5 μm, 95% CI: [−118, 108]μm). However, the location-independent cartilage ChangeScore was greater in those treated with early ACLR than in patients treated with optional delayed ACLR (adjusted mean difference: 403 μm [119, 687]μm). As-treated analysis showed no between-group differences for the main outcome, while the location-independent cartilage ChangeScore was greater for patients treated with early (adjusted mean difference: 632 μm [268, 996]μm) or delayed ACLR (adjusted mean difference: 449 μm [108, 791]μm) than for patients treated with rehabilitation alone. Conclusions: In young active adults with acute ACL-injury, choice of treatment strategy for the injured ACL did not modify the magnitude of 5-year change in overall femorotibial cartilage thickness. Trial registration: ISRCTN84752559.</p>},
  author       = {Wirth, W. and Eckstein, F. and Culvenor, A. G. and Hudelmaier, M. I. and Stefan Lohmander, L. and Frobell, R. B.},
  issn         = {1063-4584},
  language     = {eng},
  number       = {4},
  pages        = {518--526},
  publisher    = {Elsevier},
  series       = {Osteoarthritis and Cartilage},
  title        = {Early anterior cruciate ligament reconstruction does not affect 5 year change in knee cartilage thickness : secondary analysis of a randomized clinical trial},
  url          = {http://dx.doi.org/10.1016/j.joca.2021.01.004},
  doi          = {10.1016/j.joca.2021.01.004},
  volume       = {29},
  year         = {2021},
}