The Incidence of Post-Traumatic Osteoarthritis on Clinical Radiographs at 10 Years after Anterior Cruciate Ligament Reconstruction: Data from the MOON Nested Cohort (168)

Objectives: 1) To prospectively determine the incidence of post-traumatic osteoarthritis (PTOA) at 10 years after anterior cruciate ligament reconstruction (ACLR) in young athletic patients on clinical radiographs: and 2) to determine the average difference in clinical radiographic osteoarthritis changes (joint space narrowing [JSN] and osteophyte formation) between the ACLR and contralateral ACL-intact knees. Methods: The first 146 patients in an ongoing prospective nested cohort study within the Multicenter Orthopaedic Outcomes Network (MOON) cohort returned onsite for minimum 10-year follow-up. Inclusion criteria were that patients had a sports-related ACL injury, no prior history of knee surgery, no contralateral ACL injury, and were less than 33 years of age at the time of their ACLR. Bilateral knee standing metatarsophalangeal (MTP) view radiographs were obtained and graded by International Knee Documentation Committee (IKDC), Osteoarthritis Research Society International (OARSI), and modified Kellgren-Lawrence (KL) criteria by two blinded reviewers. Inter-rater reliability was determined for all clinical radiographic OA grading criteria. The incidence and severity of ipsilateral and contralateral knee osteoarthritis were determined among patients without a contralateral ACL injury before 10-year follow-up (n=133). Results: Inter-rater reliability was substantial for IKDC (Gwet’s AC1 = 0.71), moderate for KL (0.48) and almost perfect for OARSI (0.84) grading systems. The 10-year incidence of PTOA on clinical radiographs in the ACLR knee was 43% as defined by osteophytes and 27% as defined by JSN (Table 1). In the contralateral ACL-intact knee, the incidence of osteophyte-defined OA was 10% and JSN-defined OA was 5%. The maximum side-to side difference in medial or lateral compartment OARSI osteophyte grade was 0 in 65% of patients, 1 in 20%, and 2+ in 15% (Figure 1) (Table 2). The maximum difference in OARSI JSN grade was 0 in 77% of patients, 1 in 19%, and 2+ in 4% (Figure 2) (Table 2). Conclusions: In young active patients, the 10-year incidence on clinical radiographs of osteophyte-defined PTOA after ACLR is 43% and JSN-defined PTOA is 27%. The average difference in degree of osteophyte formation (≤1 grade in 85%) and JSN (≤1 grade in 96%) between the ACLR knee and contralateral ACL-intact knee is small.

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Higher Incidence of Post-traumatic Radiographic Osteoarthritis with Transtibial Femoral Tunnel Positioning Compared to Anteromedial Femoral Tunnel Positioning During Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis (208)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00317 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0031

Author(s):

Mark Cinque ◽

Kyle Kunze ◽

Brady Williams ◽

Gilbert Moatshe ◽

Robert LaPrade ◽

...

Keyword(s):

Ligament Reconstruction ◽

Femoral Tunnel ◽

Cruciate Ligament ◽

Meta Analysis ◽

Cruciate Ligament Reconstruction ◽

Post Traumatic ◽

The Mean ◽

Anterior Cruciate ◽

Tunnel Positioning

Objectives: Anteromedial (AM) femoral tunnel positioning in anterior cruciate ligament reconstruction (ACLR) has been reported by some authors to yield superior clinical and functional outcomes compared to the transtibial (TT) approach; however, differences in the subsequent rates of post-traumatic osteoarthritis (PTOA) incidence are not clear. To perform a systematic review and meta-analysis of the literature to evaluate the influence of femoral tunnel positioning during primary ACLR on the development of radiographic PTOA. Methods: The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (1980-2019), and MEDLINE (1980-2019) were queried for all studies describing the development of PTOA following TT or AM ACLR. Data pertaining to patient demographics, ACLR technique, and radiographic PTOA were extracted. Meta-analysis utilizing the DerSimonian Laird method for random effects was used to compare the weighted proportion of PTOA after ACLR between the TT and AM approaches. Results: Sixteen studies were identified for inclusion with a total of 1,546 patients. The mean follow-up across all studies was 10.9 years (range 5-17.8 years). The mean follow-up specifically in the AM and TT groups were 10.8 years (range, 5.4-17 years) and 11.4 years (range, 6-17.8 years), respectively. A total of 783 (50.6%) patients underwent TT ACLR. Of these patients, 401 (49.3%) developed radiographic PTOA. A total of 763 (49.4%) patients underwent AM ACLR. Of these patients, 324 (mean: 21.8%) went on to develop radiographic PTOA. Meta-analysis demonstrated a significantly greater rate of PTOA following ACLR using a TT technique compared to an AM reconstruction technique overall (49.3% vs.25.4%, p<0.001) and when studies were stratified by 5-10 (53.7% vs. 14.2%, p<0.001) and at greater than 10 year (45.6 % vs. 31.2%, p<0.001) follow-up. Conclusions: Transtibial ACLR is associated with higher overall rates of radiographic PTOA compared to the AM ACLR approach. The rates of radiographic PTOA following ACLR with a TT approach are also significantly higher than using an AM approach when stratified by length of follow-up (5-10 and greater than 10-year follow-up).

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Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04350-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hai Jiang ◽

Lei Zhang ◽

Rui-Ying Zhang ◽

Qiu-Jian Zheng ◽

Meng-Yuan Li

Keyword(s):

Ligament Reconstruction ◽

Cruciate Ligament ◽

Quadriceps Strength ◽

Anatomical Reconstruction ◽

Single Bundle ◽

Knee Stability ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate ◽

Reconstruction Group

Abstract Background Strength recovery of injured knee is an important parameter for patients who want to return to sport after anterior cruciate ligament reconstruction (ACLR). Comparison of muscle strength between anatomical and non-anatomical ACLR has not been reported. Purpose To evaluate the difference between anatomical and non-anatomical single-bundle ACLR in hamstring and quadriceps strength and clinical outcomes. Methods Patients received unilateral primary single-bundle hamstring ACLR between January 2017 to January 2018 were recruited in this study. Patients were divided into anatomical reconstruction group (AR group) and non-anatomical reconstruction group (NAR group) according to femoral tunnel aperture position. The hamstring and quadriceps isokinetic strength including peak extension torque, peak flexion torque and H/Q ratio were measured at an angular velocity of 180°/s and 60°/s using an isokinetic dynamometer. The isometric extension and flexion torques were also measured. Hamstring and quadriceps strength were measured preoperatively and at 3, 6, and 12 months after surgery. Knee stability including Lachman test, pivot-shift test, and KT-1000 measurement and subjective knee function including International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated during the follow-up. Results Seventy-two patients with an average follow-up of 30.4 months (range, 24–35 months) were included in this study. Thirty-three were in AR group and 39 in NAR group. The peak knee flexion torque was significant higher in AR group at 180°/s and 60°/s (P < 0.05 for both velocity) at 6 months postoperatively and showed no difference between the two groups at 12 months postoperatively. The isometric knee extension torque was significant higher in AR group at 6 months postoperatively (P < 0.05) and showed no difference between the two groups at 12 months postoperatively. No significant differences between AR group and NAR group were found regarding knee stability and subjective knee function evaluations at follow-up. Conclusions Compared with non-anatomical ACLR, anatomical ACLR showed a better recovery of hamstring and quadriceps strength at 6 months postoperatively. However, the discrepancy on hamstring and quadriceps strength between the two groups vanished at 1 year postoperatively.

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