Increased Risk of Osteoarthritis
After Anterior Cruciate Ligament Reconstruction: A 14-Year Follow-up Study of a
Randomized Controlled Trial

B, Ponzer S, Shalabi A, Bujak R, Norlen L, & Eriksson K.  Am J
Sports Med. 
2014 Published Online
First March 18, 2014: doi: 10.1177/0363546514526139

Take Home Message:  Knees with a history of an anterior cruciate
ligament injury are more likely to have osteoarthritis compared with a healthy
contralateral knee but graft selection has no effect on long-term outcomes, such
as osteoarthritis or knee functional outcomes.

individual with a history of an acute knee injury, including anterior cruciate
ligament (ACL) injury, is three to 6 six times more likely to have knee osteoarthritis
(OA) than someone without a history of injury. 
Unfortunately, we lack a consensus on whether ACL reconstruction timing
and graft selection affects the risk for knee OA.  Therefore, the authors completed an extended follow
up of a randomized clinical trial that compared quadrupled semitendinosus
tendon and bone-patellar tendon-bone grafts. They aimed to determine if graft
selection influenced the prevalence of OA 14 years after surgery.  The authors assessed 135 (82%) participants
from the original trial. Three radiologists assessed the presence of OA in both
knees with weight-bearing radiographs and knee function was assessed via the Knee Injury and Osteoarthritis Outcome Score (KOOS).  Roughly 50-70% of knees with an ACL
reconstruction had radiographic OA compared with 10-25% of healthy
contralateral knees. The authors found no difference in the prevalence of OA
between the two graft choices. Concomitant meniscectomy at the time of ACL reconstruction
increased the odds of having OA compared with individuals who had a meniscal
repair or no meniscal injury.  The
authors also observed that time between injury and reconstruction did not
influence the chances of presenting with OA. 
As expected, KOOS scores were lower among patients that had radiographic
evidence of OA (especially in the medial compartment) in comparison with those
that did not have any evidence of OA.

study supports the notion that ACL graft selection does not affect long-term
outcomes (e.g., OA prevalence, function). 
The high prevalence of OA among knees with an ACL reconstruction also
supports previous clinical trials that found that an ACL reconstruction may not
protect a knee from OA as discussed in previous posts.  This is particularly concerning since the
average age of participants at follow-up was only 39 to 42 years. Interestingly,
this study further supports the notion that concomitant meniscal resection at
the time of ACL reconstruction places an individual at a higher risk for OA. It
is important to note, that the authors excluded participants who had additional
surgery on the involved knee or the contralateral (healthy) knee for
follow-up.  It would be interesting to
see if the authors found any trends among those who needed surgery on either
knee within the follow up period.  It
would seem reasonable that the prevalence rates reported in this study may be
lower than what we may see in the clinical setting because the authors excluded
these patients. Overall, this study further highlights that a large number of
individuals with an ACL injury may have OA early in life and that meniscal
status could be a key risk factor. In a medical community focused on
prevention, we need to strive to prevent not just injuries but also chronic
pain conditions like OA that could affect our patients for over half their

Questions for Discussion:  Do
you think that ACL injury is the primary culprit of OA development or is it
underlying concomitant injury?  Are there
any other clinical findings that you see that may lead people to be more
susceptible to OA development after knee injury?
by: Nicole Cattano
by: Jeffrey Driban

Related Posts:

Barenius, B., Ponzer, S., Shalabi, A., Bujak, R., Norlen, L., & Eriksson, K. (2014). Increased Risk of Osteoarthritis After Anterior Cruciate Ligament Reconstruction: A 14-Year Follow-up Study of a Randomized Controlled Trial The American Journal of Sports Medicine DOI: 10.1177/0363546514526139