Rheumatology International

, Volume 32, Issue 5, pp 1197–1208 | Cite as

Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears

  • Verena Stein
  • Ling Li
  • Grace Lo
  • Ali Guermazi
  • Yuqing Zhang
  • C. Kent Kwoh
  • Charles B. Eaton
  • David J. HunterEmail author
Original Article


Anterior cruciate ligament (ACL) tears are known to be a risk factor for incident knee osteoarthritis (OA). At the present time, it is unknown whether an incidental ACL tear in those with established knee OA alters the pattern of synovial joint damage. Therefore, our aim was to assess whether ACL tears in persons with knee OA are associated with specific patterns of cartilage loss, meniscal degeneration, and bone marrow lesion (BML) location. We included 160 participants from the progression subcohort of the Osteoarthritis Initiative (OAI) Study, an ongoing 4-year, multicenter study, focusing on knee OA. Regional cartilage morphometry measures including cartilage volume (mm3), denuded area, normalized cartilage volume, bone surface area, as well as location of meniscal pathology and BMLs in index knees on the same side were compared between those with and without ACL tears. Of the 160 subjects (51% women, age 62.1 (±9.9), BMI 30.3 (±4.7) kg/m2), 14.4% had an ACL tear. After adjusting for age, BMI and gender participants with ACL tears had significantly greater cartilage volume in the posterior lateral femur (P = 0.04) and the central medial tibia (0.001) compared to those without ACL tears. Normalized cartilage volume was not different between those with and without ACL tears. In addition, individuals with ACL tears had significantly larger bone surface areas in the medial tibia (P = 0,006), the central medial tibia (P = 0.008), the posterior lateral femur (P = 0.004), and the posterior medial femur (P = 0.04). Furthermore, participants with ACL tears showed significantly more meniscal derangement in the lateral posterior horn (P = 0.019) and significantly more BMLs in the lateral femur (P = 0.0025). We found clear evidence of predominant lateral tibiofemoral involvement, with OA-associated findings on MRI, including increased denuded area and bone surface area, BMLs, and meniscal derangement in knees of individuals with ACL tears compared to those without.


Knee osteoarthritis Anterior cruciate ligament tear Cartilage loss Bone marrow lesions Meniscal pathology 



We would like to thank the participants and staff of the OAI. We would like to thank the Principal Investigators (Michael Nevitt, Kent Kwoh, Charles B. Eaton, Rebecca Jackson, Marc Hochberg, Joan Bathon), Co-Investigators, and staff of the Osteoarthritis Initiative. The OAI is a public–private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript has received the approval of the OAI Publications Committee based on a review of its scientific content and data interpretation. We would also like to acknowledge the following persons who contributed to this work: Piran Aliabadi (read the knee—X-ray films) and David Felson (chaired the X-ray adjudication sessions).

Conflict of interest

Nothing to declare. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Verena Stein
    • 1
  • Ling Li
    • 1
  • Grace Lo
    • 2
  • Ali Guermazi
    • 3
  • Yuqing Zhang
    • 3
  • C. Kent Kwoh
    • 4
  • Charles B. Eaton
    • 5
  • David J. Hunter
    • 1
    • 6
    Email author
  1. 1.Division of ResearchNew England Baptist HospitalBostonUSA
  2. 2.Division of RheumatologyTufts University School of MedicineBostonUSA
  3. 3.Boston University School of Medicine at Boston Medical CenterBostonUSA
  4. 4.University of Pittsburgh and Pittsburgh VA Healthcare SystemPittsburghUSA
  5. 5.Warren Alpert Medical School of Brown UniversityProvidenceUSA
  6. 6.Northern Clinical SchoolUniversity of SydneySydneyAustralia

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