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. 2005 Oct;16(5):354-362.
doi: 10.1097/01.bco.0000176423.07865.d2.

Ligament Injury, Reconstruction and Osteoarthritis

Braden C Fleming  1 , Michael J Hulstyn, Heidi L Oksendahl, Paul D Fadale
Affiliations

Ligament Injury, Reconstruction and Osteoarthritis

Braden C Fleming et al. Curr Opin Orthop. 2005 Oct.

Abstract

PURPOSE OF REVIEW: The recent literature on the factors that initiate and accelerate the progression of osteoarthritis following ligament injuries and their treatment is reviewed. RECENT FINDINGS: The ligament-injured joint is at high risk for osteoarthritis. Current conservative (e.g. rehabilitation) and surgical (e.g. reconstruction) treatment options appear not to reduce osteoarthritis following ligament injury. The extent of osteoarthritis does not appear dependent on which joint is affected, or the presence of damage to other tissues within the joint. Mechanical instability is the likely initiator of osteoarthritis in the ligament-injured patient. SUMMARY: The mechanism osteoarthritis begins with the injury rendering the joint unstable. The instability increases the sliding between the joint surfaces and reduces the efficiency of the muscles, factors that alter joint contact mechanics. The load distribution in the cartilage and underlying bone is disrupted, causing wear and increasing shear, which eventually leads to the osteochondral degeneration. The catalyst to the mechanical process is the inflammation response induced by the injury and sustained during healing. In contrast, the inflammation could be responsible for onset, while the mechanical factors accelerate progression. The mechanisms leading to osteoarthritis following ligament injury have not been fully established. A better understanding of these mechanisms should lead to alternative surgical, drug, and tissue-engineering treatment options, which could eliminate osteoarthritis in these patients. Progress is being made on all fronts. Considering that osteoarthritis is likely to occur despite current treatment options, the best solution may be prevention.

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Figures

Figure 1
Figure 1
Onset and progression of osteoarthritis Many factors are thought to contribute to the onset and progression of osteoarthritis following a ligament injury; however, the mechanisms responsible remain unknown. Factors such as mechanical instability may alter cartilage metabolism, which in turn causes cartilage breakdown, leading to arthritis.
Figure 2
Figure 2
Concentrations of biomarkers of articular cartilage metabolism from synovial fluid after anterior cruciate ligament reconstruction suggest that the articular cartilage undergoes metabolic changes For example, the concentration of the marker for aggrecan turnover (the 846-epitope) was elevated relative to the control knee (solid line) over the first 12 months and then approached that of normal by 24 months. It is unknown whether this marker will remain at the normal levels or continue to drop with time. Adapted with permission [43••].
Figure 3
Figure 3
Plausible mechanical mechanism for the onset and progression of osteoarthritis following ligament injury Reproduced with permission [56••].
See this image and copyright information in PMC

References

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