THE ROLE OF COMBINED MENISCUS AND CARTILAGE INJURIES IN OA DEVELOPMENTĪ key factor that contributes to the development of OA is the presence of combined injuries, i.e., the presence of meniscal or chondral injury combined with ACL tear. Further research that can identify additional risk factors that play a major role in OA development - apart from knee stability - is of paramount importance. The phenomena that can potentially lead to increased OA prevalence after ACL reconstruction are poorly understood. However, most studies that compare the degree of cartilage degeneration between patients undergoing ACL reconstruction and patients with non-operative treatment showed either reduction in the risk of OA development or no difference in risk. These findings are typically attributed to the higher incidence of meniscus injury in these patients. In contrast, the relative risk in ACL-reconstructed knees was 4.71. Specifically, the relative risk of progression to severe OA in ACL-injured knees using Kellgren and Lawrence grade III or IV was found to be 3.84 compared to the controls. Furthermore, a more severe degree of OA using radiographic criteria was shown after ACL reconstruction compared to ACL-injured knees. Similarly, another report demonstrated that patients that underwent ACL reconstruction had a higher incidence of knee OA. Specifically, a retrospective cohort study at 11 years post ACL injury showed that only 25% of conservatively treated knees developed OA vs 42% in ACL reconstructed knees. Some studies demonstrated that ACL reconstruction not only cannot fully prevent development of OA, but, in certain occasions, ACL reconstruction may be associated with a higher prevalence of knee OA.
The presence of a higher risk for OA compared to the uninjured knee, demonstrates that ACL reconstruction cannot fully eliminate the increased risk of OA progression. These data suggest that ACL reconstruction can prevent OA development to a certain degree.
A relative risk of 3.89 for ACL-injured knees existed towards OA (240 out of 465) compared to contralateral knees (73 out of 507). Non-operative treated ACL-deficient knees showed a relative risk of 4.98 (40 out of 120 vs 8 out of 120), suggesting that ACL reconstruction can act preventively for OA compared to non-operative treatment. A meta-analysis of six studies evaluating progression of OA after ACL injury showed that ACL-reconstructed knees had a relative risk of 3.62 vs uninjured knees (206 out of 395 vs 62 out of 395) in OA development, indicating that ACL reconstruction cannot fully prevent OA. As a result, if knee instability and its resultant abnormal forces to cartilage was the sole factor for future OA development, ACL reconstructed knees would theoretically have similar incidence of OA compared to ACL uninjured knees.ĪCL tear was reported to be associated with a higher risk for knee OA regardless reconstruction. Undeniably, ACL reconstruction restores knee stability, knee kinematics are also reinstated, and functional scores can be also equivalent to ACL-intact knees. Using regression analysis, a prospective analysis of 292 patients with knee injury, revealed a linear correlation between radiographic scores and maximum displacement measurements.ĪCL reconstruction is the treatment of choice for symptomatic ACL deficient knees. The role of instability as a predisposing factor for cartilage degeneration was highlighted early. ACL deficiency leads to anteroposterior and rotational instability as well as functional impairment, as evidenced by subjective and objective knee functional scores.
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