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Review
. 2020 Feb;13(1):115-122.
doi: 10.1007/s12178-019-09596-w.

Osteoarthritis and ACL Reconstruction-Myths and Risks

Edward C Cheung  1 , Marcus DiLallo  2 , Brian T Feeley  2 , Drew A Lansdown  2
Affiliations
Review

Osteoarthritis and ACL Reconstruction-Myths and Risks

Edward C Cheung et al. Curr Rev Musculoskelet Med. 2020 Feb.

Abstract

Purpose of review: Anterior cruciate ligament (ACL) injury is one of the most common ligamentous injuries suffered by athletes participating in cutting sports. A common misperception is that ACL reconstruction can prevent osteoarthritis (OA). The goal of this paper is to review and discuss the contributing factors for the development of OA following ACL injury.

Recent findings: There has been interesting new research related to ACL reconstruction. As understanding of knee biomechanics following ACL injury and reconstruction has changed over time, many surgeons have changed their surgical techniques to low anterior drilling to position their femoral tunnel in an attempt to place the ACL in a more anatomic position. Even with this change in the femoral tunnel position, 85% of knees following ACL reconstruction have abnormal tibial motion compared to contralateral non-injured knees. Studies have shown increases in inflammatory cytokines in the knee following ACL injury, and newer MRI sequences have allowed for earlier objective detection of degenerative changes to cartilage following injury. Recent studies have shown that injecting IL-1 receptor antagonist and corticosteroids can modulate the post-injury inflammatory cascade. ACL reconstruction does not prevent the development of OA but can improve knee kinematics and reduce secondary injury to the cartilage and meniscus. Advancements in imaging studies has allowed for earlier detection of degenerative changes in the knee, which has allowed researchers to study how new interventions can alter the course of degenerative change in the knee following ACL injury.

Keywords: ACL reconstruction; Anterior cruciate ligament; Osteoarthritis.

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Conflict of interest statement

Edward C. Cheung and Marcus DiLallo declare that they have no conflict of interest. Brian T. Feeley reports he is a board or committee member of the American Orthopaedic Society for Sports Medicine and Orthopaedic Research Society and on the editorial or governing board for the Journal of Shoulder and Elbow Surgery and Current Reviews in Musculoskeletal Medicine. Drew A. Lansdown reports that he has research and educational support from Arthrex and Smith and Nephew and is a board or committee member of the Arthroscopy Association of North America.

Figures

Fig. 1
Fig. 1
XR and T2 weighted MRI showing early evidence of left knee medial wear and medial compartment breakdown following ACL reconstruction compared to the contralateral, non-injured knee
Fig. 2
Fig. 2
Newer imaging modalities like T1ρ MRI can detect changes to the cartilage following ACL reconstruction. This figure shows the relationship between tibial position (x-axis) and changes in T1ρ MRI relaxation values (y-axis) following ACL reconstruction. Values on the left of the origin signify that the tibia has a more posterior position and the knee may be over-constrained, whereas values to the right of the origin show that the tibia is more anterior and suggests that the graft may be loose. Borrowed with permission from Zaid et al. [26]
Fig. 3
Fig. 3
T2 weighted MRI showing the typical bone bruise pattern for ACL tear with lateral femoral contusion, posterior lateral tibial contusion, and posterior lateral meniscus tear
See this image and copyright information in PMC

References

    1. Carbone A, Rodeo S. Review of current understanding of post-traumatic osteoarthritis resulting from sports injuries. J Orthop Res. 2017;35(3):397–405. - PubMed
    1. Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: a 10-year study. Knee. 2006;13(3):184–188. - PubMed
    1. Hewett TE, Di Stasi SL, Myer GD. Current concepts for injury prevention in athletes after anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41(1):216–224. - PMC - PubMed
    1. Segawa H, Omori G, Koga Y. Long-term results of non-operative treatment of anterior cruciate ligament injury. Knee. 2001;8(1):5–11. - PubMed
    1. Daniel DM, Lou SM, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994;22(5):632–644. - PubMed