The fading athlete with an old knee: investigation of factors and outcomes after anterior cruciate ligament injury related to the development of knee osteoarthritis
Date
2016
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Publisher
University of Delaware
Abstract
Anterior cruciate ligament (ACL) injury can substantially alter the life of healthy, active individuals and lead to deleterious long-term consequences. Patients often harbor unrealistic expectations of future knee function and risk of knee osteoarthritis after ACL reconstruction. Reconstruction does not guarantee restoration of prior knee function or avoidance of post-traumatic osteoarthritis. Most individuals will experience symptomatic knee osteoarthritis within 10–20 years of ACL injury regardless of surgical or conservative management.
The overall goals of this work were 1) to identify factors early after ACL injury associated with the development of post-traumatic knee osteoarthritis 5 years later and 2) to compare long-term outcomes between operative and non-operative management of ACL injury. The central hypotheses were 1) that modifiable factors present early after ACL injury would differ between individuals who do and do not develop post-traumatic osteoarthritis and 2) that outcomes would not differ between patients treated with operative compared to non-operative management of ACL injury.
Patients with ACL injury who were managed operatively (ACL reconstruction and rehabilitation) or non-operatively (rehabilitation alone) served as subjects for this study. Patients completed biomechanical gait analysis, clinical assessment of knee function, and patient-reported outcomes before and after an extended period of pre-operative or non-operative rehabilitation, and 6 months, 1 year, 2 years, and 5 years after ACL reconstruction or non-operative rehabilitation. Radiographic assessment was completed at 5 years.
Lower knee joint loading and poor knee function were associated with post-traumatic knee osteoarthritis. By identifying modifiable factors early after ACL injury associated with early osteoarthritis development we have provided rationale to include long-term knee joint health as an important goal early after ACL injury. Patients managed both operatively and non-operatively demonstrated favorable outcomes 5 years after ACL injury. By providing clear evidence of expected long-term outcomes after operative and non-operative management of ACL injury we have opened the door to improved patient education and decision-making regarding surgical management of injury. The findings of this work provide a foundation for future research to optimize treatment strategies to decrease risk for post-traumatic osteoarthritis and prospectively identify the best candidates for surgical compared to conservative care after ACL injury.