Effects of articular cartilage and meniscus injuries at the time of surgery on osteoarthritic changes after anterior cruciate ligament reconstruction in patients under 40 years old

Arch Orthop Trauma Surg. 2009 Mar;129(3):409-15. doi: 10.1007/s00402-008-0786-4. Epub 2008 Dec 3.

Abstract

Introduction: The development of osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction is an unsolved problem. Articular cartilage and meniscus injuries are particularly important factors that contribute to OA progression.

Aim: The purpose of this study was to investigate how articular cartilage and meniscus injuries at the time of surgery affected the development of OA under limited conditions retrospectively. Exclusion criteria of this study were (1) age 40 years or over, (2) previous surgery, (3) another combined knee ligament injury, and (4) unstable reconstructed knees.

Material: This study included 49 knees in 46 patients (average 26 years; range, 13-39 years) who had undergone isolated ACL reconstruction. Mean follow-up period was 3.9 years (range, 2-8 years). We classified patients into two groups, cartilage-damaged and non-damaged. Patients were also classified into two groups on the basis of treatment for meniscus: meniscectomy group and meniscus intact group. OA changes were investigated using weigh-bearing anteroposterior radiographs taken before surgery and at evaluation. OA changes were evaluated in terms of joint space narrowing, atrophy, sclerosis, cysts, spurs, flattening of the femoral condyle, concavity of the tibial condyle, and sharpening of the eminence. Each parameter was scored, and the total number of points was recorded as the OA score.

Results: Differences between the preoperative OA score and that at evaluation were defined as the increase of the OA score. OA progressed in 28 knees (57%). OA score was higher at evaluation than before surgery (P < 0.001). In the cartilage-damaged group, the Lysholm score at evaluation was lower (P < 0.05) and the increase in the OA score was higher than in the non-damaged group (P < 0.05). The increase in the OA score was higher in the meniscectomy group (P < 0.05).

Conclusion: We concluded that patients with cartilage damage and who had undergone meniscectomy show more progression of OA. These patients require long-term follow-up.

Level of evidence: Level 4, case series, therapeutic studies, investigating the results of treatment.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries
  • Cartilage, Articular / injuries*
  • Female
  • Humans
  • Knee Injuries / complications*
  • Knee Injuries / physiopathology
  • Knee Injuries / surgery
  • Male
  • Orthopedic Procedures
  • Osteoarthritis, Knee / etiology*
  • Osteoarthritis, Knee / surgery
  • Reconstructive Surgical Procedures
  • Retrospective Studies
  • Tibial Meniscus Injuries*
  • Young Adult