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Anterior Cruciate Ligament injury, Patient Variables, Outcomes and Knee Osteoarthritis

Neuman, Paul LU (2010) In Lund University Faculty of Medicine Doctoral Dissertation Series 2010:69.
Abstract
The ruptured anterior cruciate ligament (ACL) leads to immediate symptoms that severely affect the individual and receives great attention among the scientific community, yet there is still no consensus on the optional form of treatment. An ACL injury is also a well known high risk factor for the development of knee osteoarthritis (OA) some decades later. Knee OA development after an ACL injury is multi-factorial. All patient variables must be further explored before better guidelines on ACL injury treatment can be issued.



I studied 100 patients with an acute complete ACL tear over 15 years and evaluated the outcome after a primary non-surgical treatment algorithm based on early neuromuscular knee rehabilitation by a... (More)
The ruptured anterior cruciate ligament (ACL) leads to immediate symptoms that severely affect the individual and receives great attention among the scientific community, yet there is still no consensus on the optional form of treatment. An ACL injury is also a well known high risk factor for the development of knee osteoarthritis (OA) some decades later. Knee OA development after an ACL injury is multi-factorial. All patient variables must be further explored before better guidelines on ACL injury treatment can be issued.



I studied 100 patients with an acute complete ACL tear over 15 years and evaluated the outcome after a primary non-surgical treatment algorithm based on early neuromuscular knee rehabilitation by a physical therapist and initial activity restrictions.

Patients had less radiographic knee OA than in historical retrospective studies, and still had very small subjective symptoms. When OA was present, a concomitant meniscal injury treated by means of partial meniscectomy was the most important risk factor.

Another cohort of 29 ACL-injured patients were examined with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to estimate cartilage GAG content, as a proxy for cartilage integrity.

Results indicated knee cartilage GAG changes 2 years after an ACL injury. Patients who had sustained a meniscectomy, or had a BMI > 25 kg/m2, had the most impaired cartilage quality, which supports the contention that this method can detect a cartilage matrix change that may be indicative of increased risk of OA.



The data presented can help medical staff in decision-making when treating the ACL-injured patient. (Less)
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author
supervisor
opponent
  • Professor Spindler, Kurt, Department of Orthopaedics and Rehabilitation at Vanderbilt University Medical School, Nashville, Tennessee, USA
organization
publishing date
type
Thesis
publication status
published
subject
keywords
meniscal injury, knee osteoarthritis, knee radiography, Anterior cruciate ligament injury (ACL), delayed gadolinium-enhanced MRI of cartilage (dGEMRIC)
in
Lund University Faculty of Medicine Doctoral Dissertation Series
volume
2010:69
pages
135 pages
publisher
Department of Orthopaedics, Lund University
defense location
Aulan CRC, ingång 72, Skånes Universitetssjukhus, Malmö
defense date
2010-05-27 13:00:00
ISSN
1652-8220
ISBN
978-91-86443-85-6
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Reconstructive Surgery (013240300), Joint and Soft Tissue Unit (013242920)
id
94dac16a-ecf9-413b-8275-345b19ffb2b3 (old id 1599916)
date added to LUP
2016-04-01 13:20:16
date last changed
2019-05-22 06:17:50
@phdthesis{94dac16a-ecf9-413b-8275-345b19ffb2b3,
  abstract     = {{The ruptured anterior cruciate ligament (ACL) leads to immediate symptoms that severely affect the individual and receives great attention among the scientific community, yet there is still no consensus on the optional form of treatment. An ACL injury is also a well known high risk factor for the development of knee osteoarthritis (OA) some decades later. Knee OA development after an ACL injury is multi-factorial. All patient variables must be further explored before better guidelines on ACL injury treatment can be issued.<br/><br>
<br/><br>
I studied 100 patients with an acute complete ACL tear over 15 years and evaluated the outcome after a primary non-surgical treatment algorithm based on early neuromuscular knee rehabilitation by a physical therapist and initial activity restrictions. <br/><br>
Patients had less radiographic knee OA than in historical retrospective studies, and still had very small subjective symptoms. When OA was present, a concomitant meniscal injury treated by means of partial meniscectomy was the most important risk factor. <br/><br>
Another cohort of 29 ACL-injured patients were examined with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to estimate cartilage GAG content, as a proxy for cartilage integrity.<br/><br>
Results indicated knee cartilage GAG changes 2 years after an ACL injury. Patients who had sustained a meniscectomy, or had a BMI &gt; 25 kg/m2, had the most impaired cartilage quality, which supports the contention that this method can detect a cartilage matrix change that may be indicative of increased risk of OA.<br/><br>
<br/><br>
The data presented can help medical staff in decision-making when treating the ACL-injured patient.}},
  author       = {{Neuman, Paul}},
  isbn         = {{978-91-86443-85-6}},
  issn         = {{1652-8220}},
  keywords     = {{meniscal injury; knee osteoarthritis; knee radiography; Anterior cruciate ligament injury (ACL); delayed gadolinium-enhanced MRI of cartilage (dGEMRIC)}},
  language     = {{eng}},
  publisher    = {{Department of Orthopaedics, Lund University}},
  school       = {{Lund University}},
  series       = {{Lund University Faculty of Medicine Doctoral Dissertation Series}},
  title        = {{Anterior Cruciate Ligament injury, Patient Variables, Outcomes and Knee Osteoarthritis}},
  url          = {{https://lup.lub.lu.se/search/files/3311331/1599923.pdf}},
  volume       = {{2010:69}},
  year         = {{2010}},
}