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Association Between ACL Continuity on Magnetic Resonance Imaging at 5 Years After an Acute ACL Rupture and 11-Year Outcomes : A Secondary Analysis From the KANON Trial

Filbay, Stephanie R. ; Roemer, Frank ; Roos, Ewa M. LU ; Turkiewicz, Aleksandra LU ; Frobell, Richard LU ; Lohmander, L. Stefan LU orcid and Englund, Martin LU orcid (2025) In American Journal of Sports Medicine 53(8). p.1893-1900
Abstract

Background: Emerging evidence suggests that anterior cruciate ligament (ACL) ruptures can restore ACL fiber continuity. The relationship between ACL continuity on magnetic resonance imaging (MRI) (sign of ACL healing) and outcomes >5 years after an acute ACL rupture has not been investigated. Purpose: This study aimed to (1) describe clinical outcomes and radiographic osteoarthritis (ROA) at 11 years based on ACL continuity status at 5 years and (2) investigate the relationship between 5-year ACL continuity status and 11-year Knee Injury and Osteoarthritis Outcome Score (KOOS4) scores. Study Design: Secondary analysis of KANON randomized controlled trial; Level of evidence, 3. Methods: Overall, 105 of 121 (87%) active... (More)

Background: Emerging evidence suggests that anterior cruciate ligament (ACL) ruptures can restore ACL fiber continuity. The relationship between ACL continuity on magnetic resonance imaging (MRI) (sign of ACL healing) and outcomes >5 years after an acute ACL rupture has not been investigated. Purpose: This study aimed to (1) describe clinical outcomes and radiographic osteoarthritis (ROA) at 11 years based on ACL continuity status at 5 years and (2) investigate the relationship between 5-year ACL continuity status and 11-year Knee Injury and Osteoarthritis Outcome Score (KOOS4) scores. Study Design: Secondary analysis of KANON randomized controlled trial; Level of evidence, 3. Methods: Overall, 105 of 121 (87%) active adults with acute ACL ruptures randomized to undergo initial exercise therapy and optional delayed ACL reconstruction (ACLR) or early ACLR and postoperative exercise therapy completed 11-year follow-up. MRI scans at 5 years were evaluated using the Anterior Cruciate Ligament OsteoArthritis Score (0-3), with grades 0 to 2 considered to represent “ACL continuity.” Patient-reported outcomes (KOOS4, 36-Item Short Form Health Survey, Tegner Activity Scale, self-reported new knee injuries), knee laxity, and radiographic findings (tibiofemoral and/or patellofemoral ROA) were assessed at 11 years. The relationship between 5-year ACL continuity and 11-year KOOS4 scores (0-100) was examined using linear regression, adjusted for age, sex, smoking, and baseline KOOS4 scores. Results: Of patients managed nonsurgically, 58% (n = 14) had ACL continuity and 42% (n = 10) had ACL discontinuity at 5 years. Analyses suggest that ACL continuity was associated with worse 11-year KOOS4 scores compared with delayed ACLR (adjusted mean difference, –20.2 [95% CI, –31.9 to −8.6]) and early ACLR (adjusted mean difference, –15.5 [95% CI, –26.4 to −4.7]) as well as similar or worse KOOS4 scores compared with ACL discontinuity (adjusted mean difference, –11.4 [95% CI, –26.5 to 3.6]). The proportion of patients with tibiofemoral ROA ranged from 14% (ACL continuity) to 23% (delayed ACLR), and the proportion of patients with patellofemoral ROA ranged from 11% (ACL discontinuity) to 41% (early ACLR). Conclusion: ACL continuity on 5-year MRI may be associated with worse patient-reported outcomes at 11 years after an ACL injury compared with early or delayed ACLR.

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author
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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anterior cruciate ligament reconstruction, magnetic resonance imaging, osteoarthritis, rehabilitation
in
American Journal of Sports Medicine
volume
53
issue
8
pages
1893 - 1900
publisher
SAGE Publications
external identifiers
  • scopus:105005599886
  • pmid:40387842
ISSN
0363-5465
DOI
10.1177/03635465251339061
language
English
LU publication?
yes
id
a551d7d3-fe2a-4609-99a2-a714fd6151a8
date added to LUP
2025-09-18 12:30:27
date last changed
2025-10-16 16:22:46
@article{a551d7d3-fe2a-4609-99a2-a714fd6151a8,
  abstract     = {{<p>Background: Emerging evidence suggests that anterior cruciate ligament (ACL) ruptures can restore ACL fiber continuity. The relationship between ACL continuity on magnetic resonance imaging (MRI) (sign of ACL healing) and outcomes &gt;5 years after an acute ACL rupture has not been investigated. Purpose: This study aimed to (1) describe clinical outcomes and radiographic osteoarthritis (ROA) at 11 years based on ACL continuity status at 5 years and (2) investigate the relationship between 5-year ACL continuity status and 11-year Knee Injury and Osteoarthritis Outcome Score (KOOS<sub>4</sub>) scores. Study Design: Secondary analysis of KANON randomized controlled trial; Level of evidence, 3. Methods: Overall, 105 of 121 (87%) active adults with acute ACL ruptures randomized to undergo initial exercise therapy and optional delayed ACL reconstruction (ACLR) or early ACLR and postoperative exercise therapy completed 11-year follow-up. MRI scans at 5 years were evaluated using the Anterior Cruciate Ligament OsteoArthritis Score (0-3), with grades 0 to 2 considered to represent “ACL continuity.” Patient-reported outcomes (KOOS<sub>4</sub>, 36-Item Short Form Health Survey, Tegner Activity Scale, self-reported new knee injuries), knee laxity, and radiographic findings (tibiofemoral and/or patellofemoral ROA) were assessed at 11 years. The relationship between 5-year ACL continuity and 11-year KOOS<sub>4</sub> scores (0-100) was examined using linear regression, adjusted for age, sex, smoking, and baseline KOOS<sub>4</sub> scores. Results: Of patients managed nonsurgically, 58% (n = 14) had ACL continuity and 42% (n = 10) had ACL discontinuity at 5 years. Analyses suggest that ACL continuity was associated with worse 11-year KOOS<sub>4</sub> scores compared with delayed ACLR (adjusted mean difference, –20.2 [95% CI, –31.9 to −8.6]) and early ACLR (adjusted mean difference, –15.5 [95% CI, –26.4 to −4.7]) as well as similar or worse KOOS<sub>4</sub> scores compared with ACL discontinuity (adjusted mean difference, –11.4 [95% CI, –26.5 to 3.6]). The proportion of patients with tibiofemoral ROA ranged from 14% (ACL continuity) to 23% (delayed ACLR), and the proportion of patients with patellofemoral ROA ranged from 11% (ACL discontinuity) to 41% (early ACLR). Conclusion: ACL continuity on 5-year MRI may be associated with worse patient-reported outcomes at 11 years after an ACL injury compared with early or delayed ACLR.</p>}},
  author       = {{Filbay, Stephanie R. and Roemer, Frank and Roos, Ewa M. and Turkiewicz, Aleksandra and Frobell, Richard and Lohmander, L. Stefan and Englund, Martin}},
  issn         = {{0363-5465}},
  keywords     = {{anterior cruciate ligament reconstruction; magnetic resonance imaging; osteoarthritis; rehabilitation}},
  language     = {{eng}},
  number       = {{8}},
  pages        = {{1893--1900}},
  publisher    = {{SAGE Publications}},
  series       = {{American Journal of Sports Medicine}},
  title        = {{Association Between ACL Continuity on Magnetic Resonance Imaging at 5 Years After an Acute ACL Rupture and 11-Year Outcomes : A Secondary Analysis From the KANON Trial}},
  url          = {{http://dx.doi.org/10.1177/03635465251339061}},
  doi          = {{10.1177/03635465251339061}},
  volume       = {{53}},
  year         = {{2025}},
}