After Anterior Cruciate Ligament Injury and Reconstruction: A Matched
TW, Johnson RJ, Slauterbeck JR, Naud S, & Beynnon BD. The American
Journal of Sports Medicine. 2013 41: 769. Epub ahead of print March 4,
and Tibiofemoral Joint Space Width Changes After ACL Injury and Reconstruction
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.
recent history of an anterior cruciate ligament injury have radiographic and
biochemical differences from healthy knees.
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.
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?
by: Nicole Cattano
by: Jeffrey Driban
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