Early anterior cruciate ligament reconstruction does not affect 5 year change in knee cartilage thickness: secondary analysis of a randomized clinical trial

W Wirth; F Eckstein; A G Culvenor; M I Hudelmaier; L Stefan Lohmander; R B Frobell

doi:10.1016/j.joca.2021.01.004

Early anterior cruciate ligament reconstruction does not affect 5 year change in knee cartilage thickness: secondary analysis of a randomized clinical trial

Osteoarthritis Cartilage. 2021 Apr;29(4):518-526. doi: 10.1016/j.joca.2021.01.004. Epub 2021 Feb 4.

Authors

W Wirth¹, F Eckstein², A G Culvenor³, M I Hudelmaier⁴, L Stefan Lohmander⁵, R B Frobell⁶

Affiliations

¹ Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany. Electronic address: wolfgang.wirth@pmu.ac.at.
² Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University, Salzburg, Austria; Chondrometrics GmbH, Ainring, Germany. Electronic address: felix.eckstein@pmu.ac.at.
³ Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; La Trobe Sport & Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia. Electronic address: A.Culvenor@latrobe.edu.au.
⁴ Department for Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria. Electronic address: martin.hudelmaier@pmu.ac.at.
⁵ Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. Electronic address: stefan.lohmander@med.lu.se.
⁶ Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden. Electronic address: richard.frobell@med.lu.se.

PMID: 33549723
DOI: 10.1016/j.joca.2021.01.004

Abstract

Objective: To compare 5-year change in femorotibial cartilage thickness in 121 young, active adults with an acute anterior cruciate ligament (ACL) tear randomized to a strategy of structured rehabilitation plus early ACL reconstruction (ACLR) or structured rehabilitation plus optional delayed ACLR.

Design: 62 patients were randomized to early ACLR, 59 to optional delayed ACLR. Magnetic resonance imaging (MRI) was acquired within 4 weeks of injury, at two- and 5-years follow-up. Main outcome was 5-year change in overall femorotibial cartilage thickness. Secondary outcomes included the location-independent cartilage ChangeScore, summarizing thinning and thickening in 16 femorotibial subregions. An exploratory as-treated comparison was performed additionally.

Results: Baseline and at least one follow-up MRI were available for 117 patients. Over 5 years, a comparable increase in overall femorotibial cartilage thickness was observed for patients randomized to early ACLR (n = 59) and patients randomized to optional delayed ACLR (n = 58, adjusted mean difference: -5 μm, 95% CI: [-118, 108]μm). However, the location-independent cartilage ChangeScore was greater in those treated with early ACLR than in patients treated with optional delayed ACLR (adjusted mean difference: 403 μm [119, 687]μm). As-treated analysis showed no between-group differences for the main outcome, while the location-independent cartilage ChangeScore was greater for patients treated with early (adjusted mean difference: 632 μm [268, 996]μm) or delayed ACLR (adjusted mean difference: 449 μm [108, 791]μm) than for patients treated with rehabilitation alone.

Conclusions: In young active adults with acute ACL-injury, choice of treatment strategy for the injured ACL did not modify the magnitude of 5-year change in overall femorotibial cartilage thickness.

Trial registration: ISRCTN84752559.

Keywords: Anterior cruciate ligament; Cartilage; Knee; MRI; Osteoarthritis.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Anterior Cruciate Ligament Injuries / rehabilitation
Anterior Cruciate Ligament Injuries / surgery*
Anterior Cruciate Ligament Reconstruction / methods*
Cartilage, Articular / diagnostic imaging*
Cartilage, Articular / pathology
Female
Humans
Knee Joint / diagnostic imaging*
Knee Joint / pathology
Magnetic Resonance Imaging
Male
Organ Size
Physical Therapy Modalities
Time Factors
Young Adult