reconstruction: A population-based matched cohort study
Dwyer T, Chahal J, Gandhi R, Mahomed N, and Wasserstein D. J Bone
Joint Surg Am.
2014; [Epub ahead of print].
Home Message: Patients who underwent cruciate ligament reconstruction were 7
times more likely to undergo prosthetic knee arthroplasty within 15 years of
surgery. Other factors that increased the risk for knee arthroplasty included
older patient age, female sex, higher comorbidity score, and a surgeon with a low
annual surgical volume.
ligament reconstruction and long-term knee health, much of the literature is
riddled with methodological limitations including, but not limited to small
sample sizes and disagreement on a radiographic threshold of osteoarthritis (OA).
A better understanding of this relationship would allow clinicians to better
inform patients of risk factors following cruciate ligament injury and
eventually mitigate those risk factors to prevent OA and the eventual need for prosthetic knee arthroplasty. With
this in mind, Leroux and colleagues completed a population-based matched cohort study to compare the rate of knee arthroplasty following cruciate ligament reconstruction with the rate of
knee arthroplasty in the general population. The authors identified 34,786 patients who had
undergone cruciate ligament reconstruction between July 1993 and March 2008
through a retrospective review of the Ontario Health Insurance Plan physician
billing records. All of the patients were 16 to 60 years of age and had no prior
knee arthroplasty or reconstruction. Each of the 30,301 case patients was
matched to 5 control patients according to patient demographics (e.g., age,
sex, comorbidity score). The authors assessed both cohorts for the occurrence
of a knee arthroplasty from 1993 to 2012 to assess knee OA. At follow-up the individuals
with a cruciate reconstruction and control cohort underwent 181 and 111 total
knee arthroplasties, respectively. The cumulative incidence of knee
arthroplasty was 7 times greater among those with a cruciate reconstruction
than control patients. The overall event rate (per 1000 person-years) was higher
for the patients with a cruciate reconstruction (0.68) than control (0.10)
patients. Patient record analysis revealed that older age (> 49 years),
female sex, higher comorbidity score, low annual surgeon volume of cruciate
ligament reconstructions (<13 reconstructions), and a reconstruction in a
university-affiliated hospital were associated with an increased risk of
requiring a knee arthroplasty. Neither meniscal repair nor debridement at the
time of reconstruction were associated with an increased risk of knee
presents clinicians with some interesting data surrounding a well-researched
topic. Patients who undergo cruciate ligament reconstruction are significantly
more likely to need a knee arthroplasty in the future. Furthermore, risk
factors such as age, female sex, higher comorbidity score, and low annual
surgeon volume of cruciate ligament reconstructions also influenced
arthroplasty risk. Clinicians should be aware of this and press upon patients
that finding an experienced surgeon can influence the long-term health of the
joint. An especially interesting finding was that meniscal injury did not
influence the risk of knee arthroplasty. This is not in agreement with much of
the existing OA literature. Perhaps undergoing a knee arthroplasty, which is a
more conservative outcome than radiographic determination of OA influenced the results
because of the follow-up period was less than 15 years. Ultimately, the data
presented in the current study is yet another building block for clinicians to
better understand about the influence that cruciate ligament injury and reconstruction
has on the long-term health of the knee joint. We can use this knowledge to
educate our patients with a cruciate ligament rupture.
information could be a useful tool to educate your patients with an ACL rupture?
Do you feel athletes would be receptive to hearing about such long-term consequences
as knee arthroplasty?
Leroux T, Ogilvie-Harris D, Dwyer T, Chahal J, Gandhi R, Mahomed N, & Wasserstein D (2014). The risk of knee arthroplasty following cruciate ligament reconstruction: a population-based matched cohort study. The Journal of Bone and Joint Surgery. American Volume, 96 (1), 2-10 PMID: 24382718