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ACL reconstruction carries higher risk of OA than nonoperative treatment
Surgically treating ACL ruptures may improve function, but is it worth the consequences?
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HOLLYWOOD, Fla., U.S.A. – Patients who undergo ACL reconstruction surgery may significantly improve function – but at the risk of developing osteoarthritis later.
Swiss researchers conducted a 94-patient study, comparing the postop function and osteoarthritis development between isolated ACL rupture patients treated with reconstructive surgery and those treated conservatively.
Researchers found significantly higher postoperative International Knee Documentation Committee (IKDC) scores for the reconstructive group. But 42% of patients in that group developed osteoarthritis, compared to 25% in the conservative treatment group, according to Markus Alexander Kessler, MD, of the Kantonsspital St. Gallen in Switzerland.
“We had a significant [improvement] for the reconstructive patients in the IKDC score, but it is our opinion that it was because it included the laxity in the patients,” Kessler said at the Arthroscopy Association of North America 25th Annual Meeting.
The matched-pair study included 47 patients in the reconstructive group and 47 patients in the conservative group. Among these patients were 60 men and 34 women with an average age of 32 years (range, 13 years to 54 years). Surgeons chose treatment based on patient preference and arthroscopic diagnosis, Kessler said.
“After initial trauma, the working diagnosis was estimated as an ACL rupture and in every case arthroscopy was performed to determine a conservative or reconstructive treatment,” Kessler said. “No additional lesions – extra- or intra-articular – were included in this study.”
At a mean 11.4-year follow-up, researchers performed clinical and radiological evaluations, as well as Tegner and IKDC scoring. They classified the degree of osteoarthritis using the Kellgren and Lawrence scale, Kessler said.
IKDC, osteoarthritis results
The reconstructive patient group demonstrated significantly better IKDC results than the conservative treatment group, as follows (P<.05):
- 15% conservative treatment patients vs. 51% of the reconstructive patients experienced “normal” function;
- 42% conservative treatment vs. 17% reconstructive experienced “nearly normal” function;
- 29% conservative treatment vs. 23% reconstructive experienced “abnormal” function; and
- 14% conservative treatment vs. 9% reconstructive experienced “severely abnormal” function.
Using the Kellgren and Lawrence scale to determine the osteoarthritis risk, the researchers found that 58% of conservative treatment patients fell into Grade 0 (no significant changes), compared to 47% of the reconstructive group patients. They classified 17% of the conservative treatment group and 11% of the reconstructive group as Grade 1 (minute osteophyte).
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The researchers further found that 21% of the nonoperative patients and 38% of the operative patients fell into the Grade 2 classification or “definite osteophyte.” Four patients from each group were classified as Grade 3 or “diminution joint.” No patients were classified as Grade 4, indicated by an impaired joint space, Kessler said.
Tegner score results
Preoperatively both patient groups had an average Tegner score of 5.7. At postop, the scores were a mean 5.1 in the nonoperative group and a mean 4.9 in the operative group.
“The difference in Tegner score … the delta ... had no significance between the reconstructive and conservative patients (P=.16),” Kessler said.
He added that researchers found two ACL re-ruptures in the reconstructive group, while none of the conservative treatment group patients required ACL reconstruction over the follow-up period.
For more information:
- Kessler MA, Behrend H, Rukavina A, et al. Function and osteoarthritis after ACL rupture: 12-year follow-up results after nonoperative vs. operative treatment. #SS-08. Presented at the Arthroscopy Association of North America 25th Annual Meeting. May 18-21, 2006. Hollywood, Florida, U.S.A.