Clinically relevant subgroups exist among athletes who have ruptured their anterior cruciate ligaments: A Delaware-Oslo Cohort Study
Date
2023-03-01
Authors
Arhos, Elanna K.
Pohlig, Ryan T.
Di Stasi, Stephanie
Risberg, May Arna
Snyder-Mackler, Lynn
Grävare Silbernagel, Karin
Journal Title
Journal ISSN
Volume Title
Publisher
Arthritis Care & Research
Abstract
Objective:
To identify subgroups of individuals with anterior cruciate ligament (ACL) injuries based on patient characteristics, self-reported outcomes, and functional performance at baseline, and to associate subgroups with long-term outcomes after ACL rupture.
Methods:
A total of 293 participants (45.7% male, mean ± SD age 26.2 ± 9.4 years, days from injury 58 ± 35) were enrolled after effusion, pain, and range of motion impairments were resolved and quadriceps strength was at least 70% of the uninvolved limb. Mixture modeling was used to uncover latent subgroups without a prior group classification using probabilistic assignment. Variables include demographics, functional testing, and self-reported outcome measures. Radiographic evidence of osteoarthritis (OA; i.e., Kellgren/Lawrence grade of ≥1) in the involved knee at 5 years after injury was the primary outcome of interest. Chi-square tests assessed differences in the presence of radiographic OA in the involved knee between subgroups at 5 years after ACL rupture. Secondary outcomes of interest included radiographic OA in the uninvolved knee, return to preinjury sport by 2 years, operative status, and clinical OA (classified using Luyten et al criteria) at 5 years.
Results:
Four distinct subgroups exist after ACL rupture (younger good self-report, younger poor self-report, older poor self-report, older good self-report) with 30%, 31%, 47%, and 53%, respectively, having involved knee OA. The percentage of radiographic OA was not significantly different between the groups (P = 0.059).
Conclusion:
The prevalence of OA in all subgroups is highly concerning. These results suggest there are unique subgroupings of individuals that may guide treatment after ACL rupture and reconstruction by providing support for developing a patient-centered approach.
Description
This is the peer reviewed version of the following article: Arhos, E.K., Pohlig, R.T., Di Stasi, S., Risberg, M.A., Snyder-Mackler, L. and Grävare Silbernagel, K. (2023), Clinically Relevant Subgroups Among Athletes Who Have Ruptured Their Anterior Cruciate Ligaments: A Delaware-Oslo Cohort Study. Arthritis Care Res. https://doi.org/10.1002/acr.25089, which has been published in final form at https://doi.org/10.1002/acr.25089. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited. This article will be embargoed until 3/1/2024.
Keywords
Citation
Arhos, E.K., Pohlig, R.T., Di Stasi, S., Risberg, M.A., Snyder-Mackler, L. and Grävare Silbernagel, K. (2023), Clinically Relevant Subgroups Among Athletes Who Have Ruptured Their Anterior Cruciate Ligaments: A Delaware-Oslo Cohort Study. Arthritis Care Res. https://doi.org/10.1002/acr.25089