Anterior Cruciate Ligament injury, Patient Variables, Outcomes and Knee Osteoarthritis

The ruptured anterior cruciate ligament (ACL) leads to immediate symptoms that severely affect the individual and receives great attention among the scientific community, yet there is still no consensus on the optional form of treatment. An ACL injury is also a well known high risk factor for the development of knee osteoarthritis (OA) some decades later. Knee OA development after an ACL injury is multi-factorial. All patient variables must be further explored before better guidelines on ACL injury treatment can be issued.

I studied 100 patients with an acute complete ACL tear over 15 years and evaluated the outcome after a primary non-surgical treatment algorithm based on early neuromuscular knee rehabilitation by a physical therapist and initial activity restrictions.
Patients had less radiographic knee OA than in historical retrospective studies, and still had very small subjective symptoms. When OA was present, a concomitant meniscal injury treated by means of partial meniscectomy was the most important risk factor.
Another cohort of 29 ACL-injured patients were examined with delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) to estimate cartilage GAG content, as a proxy for cartilage integrity.
Results indicated knee cartilage GAG changes 2 years after an ACL injury. Patients who had sustained a meniscectomy, or had a BMI > 25 kg/m2, had the most impaired cartilage quality, which supports the contention that this method can detect a cartilage matrix change that may be indicative of increased risk of OA.

The data presented can help medical staff in decision-making when treating the ACL-injured patient.