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The development of long-term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

The high incidence of osteoarthritis (OA) in relatively young sportspeople following anterior cruciate ligament (ACL) reconstruction is concerning. Surgery is considered to reduce the development of OA compared to conservative management. This long-term study aimed to compare the incidence and severity of tibiofemoral OA (TFOA) and patellofemoral OA (PFOA) between reconstructed and non-reconstructed treatment groups and to determine which factors influence the development of OA.

Materials and methods

Fifty-six ACL-reconstructed and 45 conservatively treated patients from a cohort of 330 were followed for 11 years (mean) post-injury. Twenty-nine patients had received a bone–patellar tendon–bone (B-PT-B) graft, and 27 had received a hamstring (semitendinosus/gracilis) tendon (HT) graft. Assessment included objective and subjective stability, quadriceps and hamstring strength and radiology. Chi-square analyses compared OA between reconstructed and non-reconstructed groups and between B-PT-B, HT and non-surgical groups. Further analysis assessed the relationship between OA and age, time post-injury, meniscal injury/meniscectomy, quadriceps strength, hamstring strength, objective and subjective stability and sporting activity.

Results

Forty-eight per cent reconstructed  and 53% non-reconstructed patients developed TFOA (p = 0.690). Thirty-six per cent reconstructed and 38% non-reconstructed patients developed PFOA (p = 0.831) with moderate PFOA occurring only in the non-reconstructed group. Close to significant differences (p = 0.075) were found comparing the severity of TFOA between groups with a higher incidence of moderate/severe OA in the non-reconstructed and B-PT-B groups. TFOA differed significantly between the B-PT-B and HT groups. The development of OA was related to age, time post-injury, meniscal injury/meniscectomy, quadriceps strength and subjective stability.

Conclusions

There were no significant differences in OA incidence between reconstructed and non-reconstructed groups but fewer patients developed TFOA following HT grafting compared to B-PT-B grafting and to non-surgical treatment. Quadriceps weakness and meniscal injuries/meniscectomy, both potentially modifiable, were strongly associated with the development of TF and PFOA.

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Funding

The Nambour General Hospital Private Practitioners Fund provided funding for 42 of the x-rays.

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Authors and Affiliations

  1. The University of the Sunshine Coast, Sippy Downs, QLD, Australia

    Susan L. Keays

  2. Private Orthopaedic Clinic, Nambour, QLD, Australia

    Susan L. Keays & Anthony C. Keays

  3. The University of Queensland, Brisbane, QLD, Australia

    Peter A. Newcombe

  4. Active Rehabilitation Physiotherapy, Brisbane, QLD, Australia

    Joanne E. Bullock-Saxton

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  1. Susan L. Keays
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  2. Peter A. Newcombe
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  4. Anthony C. Keays
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Correspondence to Susan L. Keays.

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The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki. Ethical clearance was granted by the Medical Research Ethics Committee of the University of Queensland, Australia (2008000964).

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Keays, S.L., Newcombe, P.A., Bullock-Saxton, J.E. et al. The development of long-term osteoarthritis following anterior cruciate ligament injury: reconstruction vs no reconstruction. Arch Orthop Trauma Surg 143, 3201–3211 (2023). https://doi.org/10.1007/s00402-022-04662-4

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