Marie Pedersen1, Hege Grindem2,3, Bjørnar Berg4,5, Ragnhild Gunderson6, Lars Engebretsen2,4, Michael J Axe7,8, Lynn Snyder-Mackler7,9, May Arna Risberg1,4. 1. Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway. 2. Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway. 3. Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 4. Orthopedic Clinic, Oslo University Hospital, Oslo, Norway. 5. Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway. 6. Department of Radiology, Oslo University Hospital, Oslo, Norway. 7. Department of Physical Therapy, University of Delaware, Newark, Delaware, USA. 8. First State Orthopaedics, Newark, Delaware, USA. 9. Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA.
Abstract
BACKGROUND: Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices. PURPOSE: To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (<6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (>6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&L grade ≥2 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain ≤72. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&L grade ≥2/osteophyte (definite osteophyte without joint space narrowing) and K&L grade ≥1. RESULTS: At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&L grade ≥2) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&L grade ≥2/osteophyte and K&L grade ≥1, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups. CONCLUSION: There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.
BACKGROUND: Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices. PURPOSE: To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (<6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (>6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&L grade ≥2 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain ≤72. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&L grade ≥2/osteophyte (definite osteophyte without joint space narrowing) and K&L grade ≥1. RESULTS: At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&L grade ≥2) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&L grade ≥2/osteophyte and K&L grade ≥1, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups. CONCLUSION: There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.
Authors: Manish Kothari; Ali Guermazi; Gabriele von Ingersleben; Yves Miaux; Martine Sieffert; Jon E Block; Randall Stevens; Charles G Peterfy Journal: Eur Radiol Date: 2004-05-19 Impact factor: 5.315
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Authors: W M Reichmann; J F Maillefert; D J Hunter; J N Katz; P G Conaghan; E Losina Journal: Osteoarthritis Cartilage Date: 2011-03-23 Impact factor: 6.576
Authors: Marie Pedersen; Hege Grindem; Bjørnar Berg; Lars Engebretsen; Michael J Axe; Lynn Snyder-Mackler; May Arna Risberg Journal: Am J Sports Med Date: 2022-08-17 Impact factor: 7.010