Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery

Keays, Susan L., Newcombe, Peter A., Bullock-Saxton, Joanne E., Bullock, Margaret I. and Keays, Anthony C. (2010) Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery. American Journal of Sports Medicine, 38 3: 455-463. doi:10.1177/0363546509350914

Author Keays, Susan L.
Newcombe, Peter A.
Bullock-Saxton, Joanne E.
Bullock, Margaret I.
Keays, Anthony C.
Title Factors involved in the development of osteoarthritis after anterior cruciate ligament surgery
Journal name American Journal of Sports Medicine   Check publisher's open access policy
ISSN 0363-5465
Publication date 2010-03-01
Sub-type Article (original research)
DOI 10.1177/0363546509350914
Volume 38
Issue 3
Start page 455
End page 463
Total pages 9
Language eng
Formatted abstract
Background The incidence of osteoarthritis after anterior cruciate ligament reconstruction is disturbingly high, with reports of nearly 50% of patients developing mild to moderate osteoarthritis 6 years after surgery. Few studies have assessed the factors involved in the development of osteoarthritis.

Hypothesis The following 10 factors will be found to be predictive of osteoarthritis: meniscectomy, chondral damage, patellar tendon grafting, age at surgery, time delay between injury and surgery, type and intensity of postsurgery sport, quadriceps strength, hamstring strength, quadriceps-to-hamstring strength ratio, and residual joint laxity.

Study Design Cohort study (prognosis); Level of evidence, 1.

Methods Fifty-six subjects with anterior cruciate ligament reconstruction were followed for 6 years after surgery. Assessment included KT-1000 arthrometer testing, isokinetic strength testing, a return-to-sport questionnaire, and a radiograph assessment. A discriminant analysis was performed to assess which of the 10 factors could discriminate between those patients who developed tibiofemoral and patellofemoral osteoarthritis and those who did not.

Results Five factors were found to be predictive of tibiofemoral osteoarthritis. Meniscectomy (r = .72) and chondral damage (r =.41) were the strongest discriminators, followed by patellar tendon grafting (r = .37) (χ2 [7, n = 56] = 25.48; P = .001). Weak quadriceps (r = .39) and low quadriceps-to-hamstring strength ratios (r = .6) were very close discriminators (χ2 [8, n = 42] = 15.02; P = .059). For patellofemoral osteoarthritis, meniscectomy (r = .45), chondral damage (r = .75), and age at surgery (r = .65) were predictors or close predictors (χ2 [7, n = 54] = 13.30; P = .065).

Conclusion As not all 10 factors studied were predictive of osteoarthritis, the hypothesis was only partially proven. Preventing further meniscal and chondral damage in patients with anterior cruciate ligament deficiency is critical. Grafting using the hamstring tendons and restoration of quadriceps-to-hamstring strength balance are associated with less osteoarthritis.
© 2010 The Author(s)
Keyword Anterior cruciate ligament reconstruction
Patellar tendon
Hamstring tendon
Quadriceps strength
Knee osteoarthritis
Reconstructed knees
Meniscal repair
Gracilis tendon
Joint laxity
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Health and Rehabilitation Sciences Publications
School of Psychology Publications
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Citation counts: TR Web of Science Citation Count  Cited 106 times in Thomson Reuters Web of Science Article | Citations
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Created: Sun, 07 Mar 2010, 10:08:55 EST