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Mechanisms of Post-traumatic Osteoarthritis After ACL Injury

  • Osteoarthritis (MB Goldring, Section Editor)
  • Published:
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Abstract

Anterior cruciate ligament (ACL) rupture is a common and devastating injury with long-term sequelae that include meniscal tears, chondral injury, and an increased risk of knee osteoarthritis (OA). ACL reconstruction is recommended to protect against knee instability, reduce the likelihood of meniscal tears and further surgery, and enable earlier return to sporting activities. ACL reconstruction, however, does not reduce the incidence of early-onset OA. In this review, we discuss the factors before and after surgery that are believed to contribute to the premature development of degenerative joint disease.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Gianotti SM, Marshall SW, Hume PA, Bunt L. Incidence of anterior cruciate ligament injury and other knee ligament injuries: a national population-based study. J Sci Med Sport. 2009;12:622–7.

    Article  PubMed  Google Scholar 

  2. Majewski M, Susanne H, Klaus S. Epidemiology of athletic knee injuries: a 10-year study. Knee. 2006;13:184–8.

    Article  PubMed  CAS  Google Scholar 

  3. Levine JW, Kiapour AM, Quatman CE, et al. Clinically relevant injury patterns after an anterior cruciate ligament injury provide insight into injury mechanisms. Am J Sports Med. 2013;41:385–95.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lohmander LS, Ostenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. 2004;50:3145–52.

    Article  PubMed  CAS  Google Scholar 

  5. Nebelung W, Wuschech H. Thirty-five years of follow-up of anterior cruciate ligament-deficient knees in high-level athletes. Arthroscopy. 2005;21:696–702.

    Article  PubMed  Google Scholar 

  6. von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. 2004;63:269–73.

    Article  Google Scholar 

  7. Chalmers PN, Mall NA, Moric M, et al. Does ACL reconstruction alter natural history?: a systematic literature review of long-term outcomes. J Bone Joint Surg Am. 2014;96:292–300. This study concludes that ACL reconstruction does not alter the incidence of early-onset knee OA.

    Article  PubMed  Google Scholar 

  8. Cipolla M, Scala A, Gianni E, Puddu G. Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Classification, staging and timing of treatment. Knee Surg Sports Traumatol Arthrosc. 1995;3:130–4.

    Article  PubMed  CAS  Google Scholar 

  9. Mitsou A, Vallianatos P. Meniscal injuries associated with rupture of the anterior cruciate ligament: a retrospective study. Injury. 1988;19:429–31.

    Article  PubMed  CAS  Google Scholar 

  10. Nikolic DK. Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc. 1998;6:26–30.

    Article  PubMed  CAS  Google Scholar 

  11. Englund M, Lohmander LS. Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum. 2004;50:2811–9.

    Article  PubMed  CAS  Google Scholar 

  12. Yamaguchi S, Sasho T, Tsuchiya A, Wada Y, Moriya H. Long term results of anterior cruciate ligament reconstruction with iliotibial tract: 6-, 13-, and 24-year longitudinal follow-up. Knee Surg Sports Traumatol Arthrosc. 2006;14:1094–100.

    Article  PubMed  Google Scholar 

  13. Pernin J, Verdonk P, Si Selmi TA, Massin P, Neyret P. Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation. Am J Sports Med. 2010;38:1094–102.

    Article  PubMed  Google Scholar 

  14. Buckwalter JA. Articular cartilage injuries. Clin Orthop Relat Res. 2002;402:21–37.

    Article  PubMed  Google Scholar 

  15. Hanypsiak BT, Spindler KP, Rothrock CR, et al. Twelve-year follow-up on anterior cruciate ligament reconstruction: long-term outcomes of prospectively studied osseous and articular injuries. Am J Sports Med. 2008;36:671–7.

    Article  PubMed  Google Scholar 

  16. Cameron M, Buchgraber A, Passler H, et al. The natural history of the anterior cruciate ligament-deficient knee. Changes in synovial fluid cytokine and keratan sulfate concentrations. Am J Sports Med. 1997;25:751–4.

    Article  PubMed  CAS  Google Scholar 

  17. Irie K, Uchiyama E, Iwaso H. Intraarticular inflammatory cytokines in acute anterior cruciate ligament injured knee. Knee. 2003;10:93–6.

    Article  PubMed  Google Scholar 

  18. Dunn WR, Lyman S, Lincoln AE, Amoroso PJ, Wickiewicz T, Marx RG. The effect of anterior cruciate ligament reconstruction on the risk of knee reinjury. Am J Sports Med. 2004;32:1906–14.

    Article  PubMed  Google Scholar 

  19. Meunier A, Odensten M, Good L. Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up. Scand J Med Sci Sports. 2007;17:230–7.

    PubMed  CAS  Google Scholar 

  20. Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994;22:632–44.

    Article  PubMed  CAS  Google Scholar 

  21. Borchers JR, Kaeding CC, Pedroza AD, et al. Intra-articular findings in primary and revision anterior cruciate ligament reconstruction surgery: a comparison of the MOON and MARS study groups. Am J Sports Med. 2011;39:1889–93.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Potter HG, Jain SK, Ma Y, Black BR, Fung S, Lyman S. Cartilage injury after acute, isolated anterior cruciate ligament tear: immediate and longitudinal effect with clinical/MRI follow-up. Am J Sports Med. 2012;40:276–85. This study highlights the incidence of cartilage injury at the time of ACL injury and outlines its natural history over time.

    Article  PubMed  Google Scholar 

  23. Johnson DL, Urban Jr WP, Caborn DN, Vanarthos WJ, Carlson CS. Articular cartilage changes seen with magnetic resonance imaging-detected bone bruises associated with acute anterior cruciate ligament rupture. Am J Sports Med. 1998;26:409–14.

    PubMed  CAS  Google Scholar 

  24. Muir P, McCarthy J, Radtke CL, et al. Role of endochondral ossification of articular cartilage and functional adaptation of the subchondral plate in the development of fatigue microcracking of joints. Bone. 2006;38:342–9.

    Article  PubMed  CAS  Google Scholar 

  25. Frobell RB. Change in cartilage thickness, posttraumatic bone marrow lesions, and joint fluid volumes after acute ACL disruption: a two-year prospective MRI study of sixty-one subjects. J Bone Joint Surg Am. 2011;93:1096–103.

    Article  PubMed  Google Scholar 

  26. Scanzello CR, McKeon B, Swaim BH, et al. Synovial inflammation in patients undergoing arthroscopic meniscectomy: molecular characterization and relationship to symptoms. Arthritis Rheum. 2011;63:391–400.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bondeson J, Wainwright SD, Lauder S, Amos N, Hughes CE. The role of synovial macrophages and macrophage-produced cytokines in driving aggrecanases, matrix metalloproteinases, and other destructive and inflammatory responses in osteoarthritis. Arthritis Res Ther. 2006;8:R187.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Pollard TC, Gwilym SE, Carr AJ. The assessment of early osteoarthritis. J Bone Joint Surg (Br). 2008;90:411–21.

    Article  CAS  Google Scholar 

  29. Indelicato PA, Bittar ES. A perspective of lesions associated with ACL insufficiency of the knee. A review of 100 cases. Clin Orthop Relat Res. 1985;198:77–80.

    PubMed  Google Scholar 

  30. Irvine GB, Glasgow MM. The natural history of the meniscus in anterior cruciate insufficiency. Arthroscopic analysis. J Bone Joint Surg (Br). 1992;74:403–5.

    CAS  Google Scholar 

  31. Shirakura K, Terauchi M, Kizuki S, Moro S, Kimura M. The natural history of untreated anterior cruciate tears in recreational athletes. Clin Orthop Relat Res. 1995;317:227–36.

    PubMed  Google Scholar 

  32. Oiestad BE, Holm I, Engebretsen L, Aune AK, Gunderson R, Risberg MA. The prevalence of patellofemoral osteoarthritis 12 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2013;21:942–9.

    Article  PubMed  Google Scholar 

  33. Shelbourne KD, Gray T. Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five- to fifteen-year evaluations. Am J Sports Med. 2000;28:446–52.

    PubMed  CAS  Google Scholar 

  34. Ait Si Selmi T, Fithian D, Neyret P. The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up. Knee. 2006;13:353–8.

    Article  PubMed  CAS  Google Scholar 

  35. Brindle T, Nyland J, Johnson DL. The meniscus: review of basic principles with application to surgery and rehabilitation. J Athl Train. 2001;36:160–9.

    PubMed  CAS  PubMed Central  Google Scholar 

  36. Pena E, Calvo B, Martinez MA, Doblare M. A three-dimensional finite element analysis of the combined behavior of ligaments and menisci in the healthy human knee joint. J Biomech. 2006;39:1686–701.

    Article  PubMed  CAS  Google Scholar 

  37. Lohmander LS, Roos H. Knee ligament injury, surgery and osteoarthrosis. Truth or consequences? Acta Orthop Scand. 1994;65:605–9.

    Article  PubMed  CAS  Google Scholar 

  38. Hall M, Stevermer CA, Gillette JC. Gait analysis post anterior cruciate ligament reconstruction: knee osteoarthritis perspective. Gait Posture. 2012;36:56–60.

    Article  PubMed  Google Scholar 

  39. Scanlan SF, Chaudhari AM, Dyrby CO, Andriacchi TP. Differences in tibial rotation during walking in ACL reconstructed and healthy contralateral knees. J Biomech. 2010;43:1817–22.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Tashman S, Kolowich P, Collon D, Anderson K, Anderst W. Dynamic function of the ACL-reconstructed knee during running. Clin Orthop Relat Res. 2007;454:66–73.

    Article  PubMed  Google Scholar 

  41. Papannagari R, Gill TJ, Defrate LE, Moses JM, Petruska AJ, Li G. In vivo kinematics of the knee after anterior cruciate ligament reconstruction: a clinical and functional evaluation. Am J Sports Med. 2006;34:2006–12.

    Article  PubMed  Google Scholar 

  42. Beard DJ, Murray DW, Gill HS, et al. Reconstruction does not reduce tibial translation in the cruciate-deficient knee: an in vivo study. J Bone Joint Surg (Br). 2001;83:1098–103.

    Article  CAS  Google Scholar 

  43. Jansson KA, Harilainen A, Sandelin J, Karjalainen PT, Aronen HJ, Tallroth K. Bone tunnel enlargement after anterior cruciate ligament reconstruction with the hamstring autograft and endobutton fixation technique. A clinical, radiographic and magnetic resonance imaging study with 2 years follow-up. Knee Surg Sports Traumatol Arthrosc. 1999;7:290–5.

    Article  PubMed  CAS  Google Scholar 

  44. Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991;19:332–6.

    Article  PubMed  CAS  Google Scholar 

  45. Song EK, Seon JK, Yim JH, Woo SH, Seo HY, Lee KB. Progression of osteoarthritis after double- and single-bundle anterior cruciate ligament reconstruction. Am J Sports Med. 2013;41:2340–6.

    Article  PubMed  Google Scholar 

  46. Van de Velde SK, Gill TJ, DeFrate LE, Papannagari R, Li G. The effect of anterior cruciate ligament deficiency and reconstruction on the patellofemoral joint. Am J Sports Med. 2008;36:1150–9.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Darabos N, Hundric-Haspl Z, Haspl M, Markotic A, Darabos A, Moser C. Correlation between synovial fluid and serum IL-1beta levels after ACL surgery-preliminary report. Int Orthop. 2009;33:413–8.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Darabos N, Haspl M, Moser C, Darabos A, Bartolek D, Groenemeyer D. Intraarticular application of autologous conditioned serum (ACS) reduces bone tunnel widening after ACL reconstructive surgery in a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc. 2011;19 Suppl 1:S36–46.

    Article  PubMed  Google Scholar 

  49. Salmon LJ, Russell VJ, Refshauge K, et al. Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med. 2006;34:721–32.

    Article  PubMed  Google Scholar 

  50. Shelbourne KD, Urch SE, Gray T, Freeman H. Loss of normal knee motion after anterior cruciate ligament reconstruction is associated with radiographic arthritic changes after surgery. Am J Sports Med. 2012;40:108–13. This study underscores the value of knee motion after ACL reconstruction.

    Article  PubMed  Google Scholar 

  51. Roe J, Pinczewski LA, Russell VJ, Salmon LJ, Kawamata T, Chew M. A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med. 2005;33:1337–45.

    Article  PubMed  Google Scholar 

  52. Drechsler WI, Cramp MC, Scott OM. Changes in muscle strength and EMG median frequency after anterior cruciate ligament reconstruction. Eur J Appl Physiol. 2006;98:613–23.

    Article  PubMed  Google Scholar 

  53. Hart JM, Turman KA, Diduch DR, Hart JA, Miller MD. Quadriceps muscle activation and radiographic osteoarthritis following ACL revision. Knee Surg Sports Traumatol Arthrosc. 2011;19:634–40.

    Article  PubMed  Google Scholar 

  54. Ingersoll CD, Grindstaff TL, Pietrosimone BG, Hart JM. Neuromuscular consequences of anterior cruciate ligament injury. Clin Sports Med. 2008;27:383–404. vii.

    Article  PubMed  Google Scholar 

  55. Chaudhari AM, Briant PL, Bevill SL, Koo S, Andriacchi TP. Knee kinematics, cartilage morphology, and osteoarthritis after ACL injury. Med Sci Sports Exerc. 2008;40:215–22.

    Article  PubMed  Google Scholar 

  56. Palmieri-Smith RM, Thomas AC, Karvonen-Gutierrez C, Sowers MF. Isometric quadriceps strength in women with mild, moderate, and severe knee osteoarthritis. Am J Phys Med Rehabil. 2010;89:541–8.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Tourville TW, Jarrell KM, Naud S, Slauterbeck JR, Johnson RJ, Beynnon BD. Relationship between isokinetic strength and tibiofemoral joint space width changes after anterior cruciate ligament reconstruction. Am J Sports Med. 2014;42:302–11. This recent study suggests that quadriceps weakness after ACL reconstruction is associated with joint space narrowing.

    Article  PubMed  Google Scholar 

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Conflict of Interest

David Dare declares that he has no conflict of interest. Scott Rodeo reports grants from the Arthritis Foundation and AOSSM MTF Meniscus Transplantation, and research support from the Arthroscopy Association of North America, outside the submitted work. He also serves as a consultant for Rotation Medical and owns stock in Cayenne Medical.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by either of the authors.

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  1. Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA

    David Dare & Scott Rodeo

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  1. David Dare
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Correspondence to David Dare.

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This article is part of the Topical Collection on Osteoarthritis

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Dare, D., Rodeo, S. Mechanisms of Post-traumatic Osteoarthritis After ACL Injury. Curr Rheumatol Rep 16, 448 (2014). https://doi.org/10.1007/s11926-014-0448-1

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