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Acute ACL tears commonly occur in young, physically active individuals under age 30.
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ACL injury increases osteoarthritis risk resulting in early onset OA during prime work and life years between ages 30 and 50.
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Effective strategies to prevent ACL injury and to reduce OA risk after ACL tear are needed.
The Role of ACL Injury in the Development of Posttraumatic Knee Osteoarthritis
Section snippets
Key Points
The anterior cruciate ligament (ACL) a relatively common injury in young, physically active individuals. ACL injuries are seen at high incidence in adolescents playing sports that involve pivoting,
Biomechanics and basic science of PTOA
The mechanism responsible for cartilage breakdown and progression to OA following ACL injury is multifactorial and not completely understood. The development of OA after ACL injury may be the result of the initial injury to the subchondral bone and hyaline cartilage. At the time of injury, the high force of the trauma disrupts the intra-articular structures.8 Occult osteochondral lesions, or bone bruises, as measured on magnetic resonance imaging (MRI), occur in 80%–90%9 of patients with an
Risk factors for PTOA
In an effort to reduce the incidence or progression of PTOA, the identification of risk factors associated with the development of this disabling process would be beneficial. Candidate risk factors for PTOA include the following:
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Neuromuscular factors
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Meniscus status
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Body mass index (BMI)
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Chondral damage
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Age
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Graft choice
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Time interval between injury and surgical intervention.
Where do we go from here?
Surgical techniques have improved, including the advent of arthroscopic surgery and the abandonment of repair for the improved reconstructive procedures. Preservation of meniscal tissues is of the utmost importance, in which total meniscectomies are nearly nonexistent, and partial meniscectomies or meniscal repair have been the treatment of choice for concomitant meniscal injury. Early rehabilitation, both preoperatively and postoperatively, has improved outcomes. Despite these changes in
Addressing the biochemistry
From a biochemical standpoint, the ultimate method of preventing PTOA after ACL injury may be prevention of the inflammation that occurs acutely after injury. The majority of research in disease-modifying OA drugs focuses on the later stages of joint degeneration. However, in the case of PTOA, in which there is a clear precipitating event, a unique opportunity arises to intervene early in the acute posttraumatic period.61 Prevention of the cascade of destructive processes within the joint may
Rehabilitation
Whether a patient is treated nonoperatively or with ACL reconstruction, rehabilitation is an integral part of the treatment program. Rehabilitation techniques have evolved substantially over the past several decades, and the use of rehabilitation programs has become widely accepted. The goals of both nonoperative and postoperative rehabilitation include return of neuromuscular control, strength, power, and lower extremity functional symmetry.62 Depending on the patient (high-level athlete vs a
Prevention
Prevention of ACL injury is the number 1 approach to prevent PTOA. To reduce the risk of this injury, a large number of research studies are currently being conducted to identify ways to reduce the rate of ACL injuries and to improve rehabilitation after the injury.63 Currently, neuromuscular training is the most effective tool to reduce the incidence of ACL injuries.64 In a nonrandomized prospective study, female athletes enrolled in a neuromuscular and proprioceptive performance program saw
Summary
Anterior cruciate ligament tear accelerates joint degeneration and leads to osteoarthritis in a high proportion of patients. While successful in stabilizing ACL deficient knees, ACL reconstruction has not been shown to conclusively reduce OA risk. Altered biomechanics, age, meniscal status, cartilage and other joint tissue injury, as well as patient factors contribute to accelerated development of OA after ACL injury. The injury typically occurs in teenagers and young adults resulting in early
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