Background: This is a systematic review of studies on the prevalence of osteoarthritis in the tibiofemoral joint more than 10 years after an anterior cruciate ligament injury, the radiologic classification methods used, and risk factors for development of knee osteoarthritis.
Methods: A systematic search was performed in PubMed, EMBASE, and AMED. Inclusion criteria were studies involving patients with anterior cruciate ligament injury, either isolated or combined with medial collateral ligament or meniscal injury and either surgically or nonsurgically treated, and a minimum 10-year follow-up with radiologic assessment. Methodological quality was evaluated using a modified version of the Coleman methodology score.
Results: Seven prospective and 24 retrospective studies were included. The mean modified Coleman methodology score was 52 of 90. Reported prevalence of knee osteoarthritis for subjects with isolated anterior cruciate ligament injury was between 0% and 13%. For subjects with anterior cruciate ligament and additional meniscal injury, the prevalence varied between 21% and 48%. Seven different radiologic classification systems were used in the studies. Only 3 studies reported reliability results for the radiologic assessments. The most frequently reported risk factor for development of knee osteoarthritis was meniscal injury.
Conclusion: This systematic review suggests that the prevalence rates of knee osteoarthritis after anterior cruciate ligament reconstruction reported by previous reviews have been too high. The highest rated studies reported low prevalence of knee osteoarthritis for individuals with isolated anterior cruciate ligament injury (0%-13%) and a higher prevalence of knee osteoarthritis for subjects with combined injuries (21%-48%). Overall, the modified Coleman methodology score was low for the included studies. No universal methodological radiologic classification method exists, making comparisons of the studies and stating firm conclusions on the prevalence of knee osteoarthritis more than 10 years after anterior cruciate ligament injury difficult.
Aglietti P., Buzzi R., Giron F., Simeone AJ, Zaccherotti G.Arthroscopic-assisted anterior cruciate ligament reconstruction with the central third patellar tendon: a 5-8-year follow-up. Knee Surg Sports Traumatol Arthrosc. 1997;5(3):138-144.
2.
Aglietti P., Zaccherotti G., De Biase P., Taddei I.A comparison between medial meniscus repair, partial meniscectomy, and normal meniscus in anterior cruciate ligament reconstructed knees. Clin Orthop Relat Res. 1994;307:165-173.
3.
Ahlbäck S.Osteoarthrosis of the knee: a radiographic investigation. Acta Radiol Diagn (Stockh). 1968;suppl 277:7-72.
4.
Allen CR, Livesay GA, Wong EK, Woo SLInjury and reconstruction of the anterior cruciate ligament and knee osteoarthritis . Osteoarthritis Cartilage. 1999;7(1):110-121.
5.
Altman DG, Schulz KF, Moher D., et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med. 2001;134(8):663-694.
6.
Altman R., Asch E., Bloch D., et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Diagnostic and Therapeutic Criteria Committee of the American Rheumatism Association. Arthritis Rheum. 1986;29(8): 1039-1049.
7.
Altman RD, Gold GEAtlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage.2007;15(suppl A):1-56.
8.
Altman RD, Hochberg M., Murphy WA Jr, Wolfe F., Lequesne M.Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage. 1995;3(suppl A):3-70.
9.
Anderson AF, Snyder RB, Lipscomb AB Sr. Anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons augmented by the Losee iliotibial band tenodesis: a long-term study . Am J Sports Med. 1994;22(5):620-626.
10.
Bach BR Jr , Tradonsky S., Bojchuk J., Levy ME, Bush-Joseph CA, Khan NHArthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft: five- to nine-year follow-up evaluation. Am J Sports Med. 1998 ;26(1):20-29.
11.
Bahr R., Holme I.Risk factors for sports injuries: a methodological approach. Br J Sports Med. 2003;37(5):384-392.
12.
Clatworthy M., Amendola A.The anterior cruciate ligament and arthritis . Clin Sports Med.1999;18(1):173-198, vii.
13.
Cohen M., Amaro JT, Ejnisman B., et al. Anterior cruciate ligament reconstruction after 10 to 15 years: association between meniscectomy and osteoarthrosis. Arthroscopy . 2007;23(6):629-634.
14.
Coleman BD, Khan KM, Maffulli N., Cook JL, Wark JDStudies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group. Scand J Med Sci Sports. 2000;10(1):2-11.
15.
Croft P.An introduction to the Atlas of Standard Radiographs of Arthritis. Rheumatology (Oxford). 2005;44(suppl 4):iv-42.
16.
Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KRFate of the ACL-injured patient: a prospective outcome study. Am J Sports Med. 1994;22(5):632-644.
17.
Deehan DJ, Salmon LJ, Webb VJ, Davies A., Pinczewski LAEndoscopic reconstruction of the anterior cruciate ligament with an ipsilateral patellar tendon autograft: a prospective longitudinal five-year study. J Bone Joint Surg Br. 2000;82(7):984-991.
18.
Drogset JO, Grontvedt T.Anterior cruciate ligament reconstruction with and without a ligament augmentation device: results at 8-year follow-up. Am J Sports Med. 2002;30(6):851-856.
19.
Drogset JO, Grontvedt T., Robak OR, Molster A., Viset AT, Engebretsen L.A sixteen-year follow-up of three operative techniques for the treatment of acute ruptures of the anterior cruciate ligament. J Bone Joint Surg Am. 2006;88(5):944-952.
20.
Fairbank TJKnee joint changes after meniscectomy. J Bone Joint Surg. 1948;30:664-670.
21.
Felson DT, Lawrence RC, Dieppe PA, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med.2000;133(8):635-646.
22.
Fink C., Hoser C., Hackl W., Navarro RA, Benedetto KPLong-term outcome of operative or nonoperative treatment of anterior cruciate ligament rupture: is sports activity a determining variable? Int J Sports Med. 2001;22(4):304-309.
23.
Fithian DC, Paxton EW, Stone ML, et al. Prospective trial of a treatment algorithm for the management of the anterior cruciate ligament- injured knee. Am J Sports Med. 2005;33(3):335-346.
24.
Galli M., De Santis V., Tafuro L.Reliability of the Ahlback classification of knee osteoarthritis. Osteoarthritis Cartilage. 2003;11(8):580-584.
25.
Gillquist J. , Messner K.Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med. 1999; 27(3):143-156.
Gobbi A., Diara A., Mahajan S., Zanazzo M., Tuy B.Patellar tendon anterior cruciate ligament reconstruction with conical press-fit femoral fixation: 5-year results in athletes population. Knee Surg Sports Traumatol Arthrosc. 2002;10(2):73-79.
28.
Greenhalgh T.Assessing the methodological quality of published papers. BMJ. 1997;315(7103):305-308.
29.
Guyatt G., Rennie D., Evidence-Based Medicine Working Group.Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice . Chicago, Ill: AMA Press; 2002.
30.
Gwilym SE, Pollard TC, Carr AJUnderstanding pain in osteoarthritis. J Bone Joint Surg Br . 2008;90(3):280-287.
31.
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(4):671-677.
32.
Harilainen A., Linko E., Sandelin J.Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results. Knee Surg Sports Traumatol Arthrosc. 2006;14(6):517-528.
33.
Harniman E. , Carette S., Kennedy C., Beaton D.Extracorporeal shock wave therapy for calcific and noncalcific tendonitis of the rotator cuff: a systematic review. J Hand Ther. 2004;17(2):132-151.
34.
Hart AJ, Buscombe J., Malone A., Dowd GSAssessment of osteoarthritis after reconstruction of the anterior cruciate ligament: a study using single-photon emission computed tomography at ten years. J Bone Joint Surg Br. 2005;87(11):1483-1487.
35.
Hefti F., Muller W., Jakob RP, Staubli HUEvaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc. 1993;1(3-4):226-234.
Irrgang JJ, Ho H., Harner CD, Fu FHUse of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 1998;6(2):107-114.
38.
Jakobsen RB , Engebretsen L., Slauterbeck JRAn analysis of the quality of cartilage repair studies. J Bone Joint Surg Am. 2005;87(10): 2232-2239.
39.
Jarvela T., Kannus P., Jarvinen M.Anterior cruciate ligament reconstruction in patients with or without accompanying injuries: a re-examination of subjects 5 to 9 years after reconstruction. Arthroscopy. 2001;17(8):818-825.
40.
Johnston DR , Baker A., Rose C., Scotland TR, Maffulli N.Long-term outcome of MacIntosh reconstruction of chronic anterior cruciate ligament insufficiency using fascia lata. J Orthop Sci. 2003;8(6): 789-795.
Kellgren JH , Lawrence JSRadiological assessment of osteo-arthrosis . Ann Rheum Dis. 1957;16(4):494-502.
43.
Kessler MA, Behrend H., Henz S., Stutz G., Rukavina A., Kuster MSFunction, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment. Knee Surg Sports Traumatol Arthrosc. 2008;16(5):442-448.
44.
Kullmer K., Letsch R., Turowski B.Which factors influence the progression of degenerative osteoarthritis after ACL surgery? Knee Surg Sports Traumatol Arthrosc. 1994;2(2):80-84.
45.
Lebel B., Hulet C., Galaud B., Burdin G., Locker B., Vielpeau C.Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: a minimum 10-year follow-up. Am J Sports Med. 2008;36(7):1275-1282.
46.
Lohmander LS , Englund PM, Dahl LL, Roos EMThe long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. 2007;35(10):1756-1769.
47.
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(10):3145-3152.
48.
Lohmander LS , Roos H.Knee ligament injury, surgery and osteoarthrosis: truth or consequences? Acta Orthop Scand. 1994;65(6): 605-609.
49.
Maletius W. , Messner K.Eighteen- to twenty-four-year follow-up after complete rupture of the anterior cruciate ligament. Am J Sports Med. 1999;27(6):711-717.
McDaniel WJ Jr, Dameron TB Jr.Untreated ruptures of the anterior cruciate ligament: a follow-up study. J Bone Joint Surg Am. 1980;62(5):696-705.
52.
Mehta VM, Paxton LW, Fornalski SX, Csintalan RP, Fithian DCReliability of the International Knee Documentation Committee radiographic grading system. Am J Sports Med. 2007;35(6):933-935.
53.
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(3):230-237.
Murray AW, Macnicol MF10-16 year results of Leeds-Keio anterior cruciate ligament reconstruction . Knee. 2004;11(1):9-14.
56.
Myklebust G. , Bahr R.Return to play guidelines after anterior cruciate ligament surgery. Br J Sports Med. 2005;39(3):127-131.
57.
Myklebust G. , Holm I., Maehlum S., Engebretsen L., Bahr R.Clinical, functional, and radiologic outcome in team handball players 6 to 11 years after anterior cruciate ligament injury: a follow-up study. Am J Sports Med. 2003;31(6):981-989.
58.
Nakata K., Shino K., Horibe S., et al. Arthroscopic anterior cruciate ligament reconstruction using fresh-frozen bone plug-free allogeneic tendons: 10-year follow-up. Arthroscopy. 2008;24(3):285-291.
59.
Nebelung W., Wuschech H.Thirty-five years of follow-up of anterior cruciate ligament-deficient knees in high-level athletes. Arthroscopy. 2005;21(6):696-702.
60.
Neuman P., Englund M., Kostogiannis I., Friden T., Roos H., Dahlberg LEPrevalence of tibiofemoral osteoarthritis 15 years after nonoperative treatment of anterior cruciate ligament injury: a prospective cohort study. Am J Sports Med. 2008;36(9):1717-1725.
61.
Neyret P., Donell ST, Dejour H.Results of partial meniscectomy related to the state of the anterior cruciate ligament: review at 20 to 35 years. J Bone Joint Surg Br. 1993;75(1):36-40.
62.
Noyes FR, Matthews DS, Mooar PA, Grood ESThe symptomatic anterior cruciate-deficient knee, part II: the results of rehabilitation, activity modification, and counseling on functional disability . J Bone Joint Surg Am. 1983;65(2):163-174.
63.
O’Brien W.Degenerative arthritis of the knee following anterior cruciate ligament injury: role of the meniscus. Sports Med Arthrosc.1993; 1:114-118.
64.
Otto D., Pinczewski LA, Clingeleffer A., Odell R.Five-year results of single-incision arthroscopic anterior cruciate ligament reconstruction with patellar tendon autograft. Am J Sports Med. 1998;26(2):181-188.
65.
Patel JV, Church JS, Hall AJCentral third bone-patellar tendon-bone anterior cruciate ligament reconstruction: a 5-year follow-up. Arthroscopy. 2000;16(1):67-70.
66.
Petersson IF , Boegard T., Saxne T., Silman AJ, Svensson B.Radiographic osteoarthritis of the knee classified by the Ahlback and Kellgren & Lawrence systems for the tibiofemoral joint in people aged 35-54 years with chronic knee pain. Ann Rheum Dis. 1997;56(8):493-496.
67.
Pinczewski LA, Lyman J., Salmon LJ, Russell VJ, Roe J., Linklater J.A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med. 2007;35(4):564-574.
68.
Pritchard JC , Drez D. Jr, Moss M., Heck S.Long-term followup of anterior cruciate ligament reconstruction using freeze-dried fascia lata allografts. Am J Sports Med. 1995;23(5):593-596.
69.
Reid JS, Hanks GA, Kalenak A., Kottmeier S., Aronoff V.The Ellison iliotibial-band transfer for a torn anterior cruciate ligament of the knee: long-term follow-up. J Bone Joint Surg Am. 1992;74(9):1392-1402.
70.
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(9):1337-1345.
71.
Roos EMJoint injury causes knee osteoarthritis in young adults. Curr Opin Rheumatol. 2005;17(2):195-200.
72.
Roos H., Lindberg H., Gardsell P., Lohmander LS, Wingstrand H.The prevalence of gonarthrosis and its relation to meniscectomy in former soccer players. Am J Sports Med. 1994;22(2):219-222.
73.
Ruiz AL, Kelly M., Nutton RWArthroscopic ACL reconstruction: a 5-9 year follow-up. Knee . 2002;9(3):197-200.
74.
Sajovic M., Vengust V., Komadina R., Tavcar R., Skaza K.A prospective, randomized comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: five-year follow-up. Am J Sports Med. 2006 ;34(12): 1933-1940.
75.
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(5):721-732.
76.
Schiphof D. , Boers M., Bierma-Zeinstra SMDifferences in descriptions of Kellgren and Lawrence grades of knee osteoarthritis. Ann Rheum Dis. 2008;67(7):1034-1036.
77.
Segawa H., Omori G., Koga Y.Long-term results of non-operative treatment of anterior cruciate ligament injury. Knee. 2001;8(1):5-11.
78.
Selmi T., Fithian D., Neyret P.The evolution of osteoarthritis in 103 patients with ACL reconstruction at 17 years follow-up. Knee. 2006;13(5):353-358.
79.
Seon JK, Song EK, Park SJOsteoarthritis after anterior cruciate ligament reconstruction using a patellar tendon autograft. Int Orthop. 2006;30(2):94-98.
80.
Seon JK, Song EK, Park SJWhat are the risk factors in the development of osteoarthritis following ACL reconstruction [author reply]. Int Orthop. 2006;30(5):432.
81.
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(4):446-452.
Sommerlath K., Lysholm J., Gillquist J.The long-term course after treatment of acute anterior cruciate ligament ruptures: a 9 to 16 year followup. Am J Sports Med. 1991;19(2):156-162.
84.
Sprague S., Leece P., Bhandari M., Tornetta P. III, Schemitsch E., Swiontkowski MFLimiting loss to follow-up in a multicenter randomized trial in orthopedic surgery. Control Clin Trials. 2003;24(6): 719-725.
85.
Stevens KJ, Dragoo JLAnterior cruciate ligament tears and associated injuries. Top Magn Reson Imaging.2006;17(5):347-362.
86.
Strand T., Molster A., Hordvik M., Krukhaug Y.Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15-23 years postoperatively. Arch Orthop Trauma Surg. 2005;125(4):217-221.
87.
Tallon C., Coleman BD, Khan KM, Maffulli N.Outcome of surgery for chronic Achilles tendinopathy: a critical review. Am J Sports Med. 2001;29(3):315-320.
88.
van der Hart CP, van den Bekerom MP, Patt TWThe occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligament. J Orthop Surg. 2008;3:24.
89.
van Tulder MW, Touray T., Furlan AD, Solway S., Bouter LMMuscle relaxants for nonspecific low back pain: a systematic review within the framework of the Cochrane collaboration . Spine. 2003;28(17): 1978-1992.
90.
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(3):269-273.
91.
Weidow J., Cederlund CG, Ranstam J., Karrholm J.Ahlback grading of osteoarthritis of the knee: poor reproducibility and validity based on visual inspection of the joint. Acta Orthop. 2006;77(2):262-266.
92.
World Health Organization.WHO statistical information system. Available at: http://www.3.who.int/whosis/menu. Accessed February 18, 2005.
93.
Wu WH, Hackett T., Richmond JCEffects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study. Am J Sports Med. 2002;30(6):845-850.
94.
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(11):1094-1100.
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