Sports Medicine Research: In the Lab & In the Field: Early Degenerative Changes After an ACL Injury (Sports Med Res)
Wednesday, May 1, 2013

Early Degenerative Changes After an ACL Injury

Assessment of Early Tibiofemoral Joint Space Width Changes After Anterior Cruciate Ligament Injury and Reconstruction: A Matched Case-Control Study

Tourville TW, Johnson RJ, Slauterbeck JR, Naud S, & Beynnon BD. The American Journal of Sports Medicine. 2013 41: 769. Epub ahead of print March 4, 2013. DOI:10.1177/0363546513477838

Relationship Between Markers of Type II Collagen Metabolism and Tibiofemoral Joint Space Width Changes After ACL Injury and Reconstruction

Tourville TW, Johnson RJ, Slauterbeck JR, Naud S, & Beynnon BD. The American Journal of Sports Medicine. 2013 41: 779. Epub ahead of print February 19, 2013. DOI:10.1177/0363546513476481

Take Home Message: Knees with a recent history of an anterior cruciate ligament injury have radiographic and biochemical differences from healthy knees.

An anterior cruciate ligament (ACL) injury predisposes a knee to osteoarthritis.  Little is known about the causes and characteristics of the path from injury to osteoarthritis.  Without these fundamental concepts it is challenging to determine who will develop knee osteoarthritis, optimal interventions, and how to measure if the treatments are effective at preventing early joint degeneration. Therefore, the purposes of these two studies were to investigate the early biochemical and structural changes among 39 knees after an ACL injury compared with 32 healthy knees.  Patients were assessed at baseline (prior to ACL surgery) for joint space width, and then reassessed at 1- and 4-years post-surgery along with biochemical markers of collagen turnover at these follow-up visits.  The authors discovered that within 6 months of an ACL injury – but before surgery – the ACL injured knees already had less joint space width in the lateral tibiofemoral compartment compared with healthy controls.  Furthermore, 12 (32%) ACL injured knees had radiographic changes within 4 years of surgery, defined as joint space width change, compared to the control knees, which did not change. The knees with an ACL injury also had increased markers of collagen breakdown compared with controls at 1- and 4-year follow-up visits, but at the 4th year follow-up this difference may be primarily among knees with radiographic changes.   

These studies, along two other studies I recently noted on SMR (see below), suggest that we can detect early degenerative changes in joints within 5 years after an injury.  These changes are reinforced and reflected with biochemical changes as well.  This study also raised an interesting question since they detected radiographic differences within 6 months of an ACL injury: did these changes occur after the injury or was the knee different before the injury? It may be helpful if we can eventually figure out if the loss of joint space width was caused by cartilage loss or meniscal damage, since both could contribute to changes in joint space width. As healthcare professionals, we have recognized a group that is at risk for early development of osteoarthritis and we know we can detect early structural and biochemical changes.  This opens the window of opportunity to potentially try early interventions to help ward off the seemingly inevitable development of osteoarthritis.  Despite the fact that we often only work with athletes for a few years (and don’t see them when they develop osteoarthritis), we may be key figures in eventually helping them prevent being burdened with joint pain and limited function for decades. Has anyone seen anything starting to be done clinically in this population to help avoid the development of long-term knee pain?  Does anyone have any ideas of what we could potentially do to help this population’s long-term knee health?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

Related Posts:
Tourville, T., Johnson, R., Slauterbeck, J., Naud, S., & Beynnon, B. (2013). Assessment of Early Tibiofemoral Joint Space Width Changes After Anterior Cruciate Ligament Injury and Reconstruction: A Matched Case-Control Study The American Journal of Sports Medicine, 41 (4), 769-778 DOI: 10.1177/0363546513477838 
Tourville, T., Johnson, R., Slauterbeck, J., Naud, S., & Beynnon, B. (2013). Relationship Between Markers of Type II Collagen Metabolism and Tibiofemoral Joint Space Width Changes After ACL Injury and Reconstruction The American Journal of Sports Medicine, 41 (4), 779-787 DOI: 10.1177/0363546513476481

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