Low risk of moderate, severe post-traumatic OA seen 10 years after ACL reconstruction
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Young athletes who underwent ACL reconstruction had a low risk of moderate and severe post-traumatic osteoarthritis 10-years after surgery, according to study results.
“The whole point of us doing this analysis early to get a real answer on percentages is so that, when the 20-year-old who tears [an] ACL asks, ‘What does this mean for my knee in 10 years?’, [we can say] chances are good,” Joshua S. Everhart, MD, orthopedic surgeon at Indiana University Health and an assistant professor at Indiana University School of Medicine, told Healio Orthopedics.
Risk of post-traumatic OA
Everhart and his colleagues used the Kellgren-Lawrence (K-L) classification system, IKDC score and the Osteoarthritis Research Society International (OARSI) grading system to estimate the incidence of post-traumatic OA in 133 patients within the Multicenter Orthopaedic Outcomes Network cohort who underwent primary ACL reconstruction. At their 10-year follow-up visits, all patients underwent bilateral fixed-flexion posterior-anterior radiographs to measure joint space width.
“In this study, we utilized two definitions of OA,” Everhart said at the Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day Meeting where he presented the results. “The first is based on the presence of the definite tibial or femoral marginal osteophytes and the second is based on medial or lateral joint space narrowing.”
The interim findings showed 37% of patients had osteophyte-defined OA and 23% of patients had joint space narrowing-defined OA, Everhart said during his presentation, and noted most of the patients had either no OA or mild OA, 6% had grade 2 OA and 2% had grade 4 OA, based on the K-L grading system.
IKDC grading results
“When we utilized IKDC grading system, again, the vast majority had either grades A or B, 6% had grade C and 2% had grade D on the ACL reconstructed knee,” Everhart said.
Furthermore, 85% and 94% of patients had one grade or less side-to-side difference in OARSI osteophyte and joint space narrowing grade, respectively, he said.
“It is great that we can get our athletes back to sport, but they need their knees for their whole lives,” Everhart told Healio Orthopedics. “Understanding the consequences of this injury and whether or not our surgery is having any impact on their post-traumatic arthritis risks later is important and, even more so, understanding the amount of risk they have.”
Continued research
Although the results of this 10-year follow-up study were promising, a 20-year follow-up study may be the time point investigators need to see which patients may develop significant knee arthritis after ACL reconstruction, Everhart said.
“We need to look further out to see who is going to have more severe arthritis,” he told Healio Orthopedics.
In addition, Everhart and his colleagues are continuing to collect 10-year patient data in the hopes they can identify which patients are specifically at risk for developing severe arthritis.
“We need that to be able to connect how the X-rays look to how patients are actually feeling from a symptoms standpoint,” Everhart said. “That can all be done with our 400 patient sample that we have our NIH funding for.”
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Everhart JS, et al. Paper 11. Presented at: Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day; March 17 and 18, 2021 (virtual meeting).
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