Prognostic factors for tibiofemoral and patellofemoral osteoarthritis 32–37 years after anterior cruciate ligament injury managed with early surgical repair or rehabilitation alone

Summary

Objective

Explore prognostic factors for tibiofemoral (TFJ) and patellofemoral (PFJ) radiographic osteoarthritis (ROA) and ‘symptoms plus ROA’ (SOA), 32–37 years following anterior cruciate ligament (ACL) injury.

Design

Exploratory analysis, longitudinal cohort.

Methods

In 1980–1985, 251 patients aged 15–40 years with acute ACL rupture were allocated to early augmented or non-augmented repair (5 ± 4 days post-injury) plus rehabilitation, or rehabilitation alone. 127 of 190 participants who completed follow-up questionnaires were eligible. We classified ROA as TFJ/PFJ K&L Grade ≥2, and SOA as ROA plus pain and/or symptoms. Multivariable age-adjusted logistic regression investigated potential prognostic factors (assessed at 4 ± 1 year follow-up: ACL treatment, isokinetic quadriceps/hamstrings strength, single-leg-hop for distance, knee flexion/extension deficit, knee laxity, Tegner Activity Scale, Lysholm Scale; sex, baseline meniscus status).

Results

127 patients were aged 58 ± 6 years; BMI 27 ± 4 kg/m²; 28% female; 59% had TFJ-ROA, 48% had TFJ-SOA (including n = 9 knee-arthroplasties), 36% had PFJ-ROA; 27% had PFJ-SOA. Baseline meniscus surgery was a prognostic factor for TFJ-ROA (multivariable age-adjusted odds ratio (95% CI): 3.0 (1.2, 7.8)). A single-leg-hop limb symmetry index (LSI) < 90% was a prognostic factor for PFJ-ROA (5.1 (1.4, 18.7)) and PFJ-SOA (4.9 (1.2, 19.7)). Hamstrings strength LSI <90% was a prognostic factor for PFJ-SOA (5.0 (1.3, 19.3)). ACL treatment with rehabilitation-alone was associated with an 80% reduction in the odds of PFJ-SOA (0.2 (0.1–0.7)), compared with early ACL-repair.

Conclusions

These findings are hypothesis generating, research is needed to determine whether ACL-injured individuals with these characteristics benefit from interventions to prevent or delay the onset of osteoarthritis.