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Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years.

ABSTRACT: Background and purpose - Long-term rates of knee arthroplasty in patients with anterior cruciate ligament (ACL) injury who undergo ligament reconstruction (ACLr) are unclear. We determined this risk of arthroplasty through comparison with the general population.Patients and methods - All patients undergoing an ACLr in England, 1997-2017, were identified from national hospital statistics. Patients subsequently undergoing a knee arthroplasty were identified and survival analysis was performed (survival without undergoing knee arthroplasty). A Cox proportional hazards model was used to identify factors associated with knee arthroplasty. Relative risk of knee arthroplasty (total or partial) in comparison with the general population was determined.Results - 111,212 ACLr patients were eligible for analysis (mean age 29; 77% male). Overall, 0.46% (95% confidence interval [CI] 0.40-0.52) ACLr patients underwent knee arthroplasty within 5 years, 0.97% (CI 0.82-1.2) within 10 years, and 1.8% (CI 1.4-2.3) within 15 years. Knee arthroplasty risk was greater in older age groups and women. In comparison with the general population, the relative risk of undergoing arthroplasty at a younger age (at time of arthroplasty) was elevated: at 30-39 years (risk ratio [RR] 20; CI 11-35), 40-49 years (RR 7.5; CI 5.5-10), and 50-59 years (RR 2.5; CI 1.8-3.5), but not 60-69 years (RR 1.7; CI 0.93-3.2).Interpretation - Patients sustaining an ACL injury who undergo ACLr are at elevated risk of subsequent knee arthroplasty in comparison with the general population. Although the absolute rate of arthroplasty is low, the risk of arthroplasty at a younger age is particularly elevated. When the outcome of shared decision-making is ACLr, this data will help inform patients and clinicians about the long-term risk of requiring knee arthroplasty.

SUBMITTER: Abram SGF

PROVIDER: S-EPMC6844427 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years.

Abram Simon G F SGF Judge Andrew A Khan Tanvir T Beard David J DJ Price Andrew J AJ

Acta orthopaedica 20190710 6

Background and purpose - Long-term rates of knee arthroplasty in patients with anterior cruciate ligament (ACL) injury who undergo ligament reconstruction (ACLr) are unclear. We determined this risk of arthroplasty through comparison with the general population.Patients and methods - All patients undergoing an ACLr in England, 1997-2017, were identified from national hospital statistics. Patients subsequently undergoing a knee arthroplasty were identified and survival analysis was performed (sur ...[more]

PMID: 31288595

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Project description:ObjectivesPrior injury to the knee, particularly anterior cruciate ligament (ACL) injury, is known to predispose one to premature osteoarthritis (OA). The study sought to explore if there was a biomechanical rationale for this process by investigating changes in external knee moments between people with a history of ACL injury and uninjured participants during walking: (1) on different surface inclines and (2) at different speeds. In addition we assessed functional differences between the groups.Participants12 participants who had undergone ACL reconstruction (ACLR) and 12 volunteers with no history of knee trauma or injury were recruited into this study. Peak knee flexion and adduction moments were assessed during flat (normal and slow speed), uphill and downhill walking using an inclined walkway with an embedded Kistler Force plate, and a ten-camera Vicon motion capture system. Knee injury and Osteoarthritis Outcome Score (KOOS) was used to assess function. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in gait and KOOS outcomes.ResultsNo significant difference was observed in the peak knee adduction moment between ACLR and control participants, however, in further analysis, MANOVA revealed that ACLR participants with an additional meniscal tear or collateral ligament damage (7 participants) had a significantly higher adduction moment (0.33±0.12?Nm/kg?m) when compared with those with isolated ACLR (5 participants, 0.1±0.057?Nm/kg?m) during gait at their normal speed (p<0.05). A similar (non-significant) trend was seen during slow, uphill and downhill gait.ConclusionsParticipants with an isolated ACLR had a reduced adductor moment rather an increased moment, thus questioning prior theories on OA development. In contrast, those participants who had sustained associated trauma to other key knee structures were observed to have an increased adduction moment. Additional injury concurrent with an ACL rupture may lead to a higher predisposition to osteoarthritis than isolated ACL deficiency alone.

Project description:PurposeThe consequence of tunnel widening after ACL reconstructions is foremost of importance in case of revision surgery. Tunnel expansion leads to bone loss close to the joint, and additional surgery with bone grafting prior to revision surgery might be necessary. The purpose of the study was to measure widening of the tunnels in single-bundle (SB) and double-bundle (DB) ACL reconstructed knees during the first year after surgery, detected by a novel, semi-automated 3D CT imaging modality. Our hypothesis was that there would be a difference between the initial tunnel size and the size measured one year post-operatively due to the tunnel widening process. Further, the purpose was to evaluate whether there were any differences in the amount of tunnel widening between the two surgical techniques.MethodsTwenty patients who underwent DB ACL reconstruction, and 22 patients who underwent SB ACL reconstruction, performed a CT scan of the bony tunnels, during their first days after surgery and one year post-operatively. The CT scans were transformed into 3D CT reconstructions, and the tunnels were measured with the "best-fit cylinder" method, measurements at the level of tunnel aperture and 10.0 mm from the joint line.ResultsAll tunnels in the DB and SB ACL reconstructed knees exhibited widening during the first year after the operation (p < 0.001). The SB femoral tunnels showed more widening compared to the DB femoral AM tunnels (1.4 ± 0.9 vs. 0.5 ± 0.6 mm) (p < 0.001), and the SB tibial tunnels widened more compared to the DB tibial PL tunnels (1.0 ± 1.0 vs. 0.5 ± 0.6) (p < 0.043).ConclusionAll tunnels widened during the first year after the ACL reconstruction with a larger amount of widening in the SB tunnels compared to the DB femoral AM tunnels and the DB tibial PL tunnels. This is the first study to detect tunnel widening in DB reconstructed knees through a semi-automated 3D CT imaging modality.Level of evidenceProspective cohort study, Level III.

Project description:BackgroundWe aimed to evaluate clinical and radiological results after simultaneous open-wedge high tibial osteotomy (HTO) and anterior cruciate ligament (ACL) reconstruction in patients with ACL deficiency combined with medial uni-compartmental osteoarthritis (OA) and varus deformity.MethodsThis retrospective study was performed using data collected from 2005 to 2011 on a total of 24 patients who were diagnosed with ACL injury and medial unicompartmental OA with varus deformity, and who subsequently underwent simultaneous open-wedge HTO and arthroscopic ACL reconstruction. The mean follow-up duration was 5.2 years. For clinical outcomes, we evaluated Lysholm score, Tegner activity score, range of motion, Lachmann test, and pivot-shift test, and for radiological outcomes, we evaluated the degree of varus deformity, progression of medial OA, tibial posterior slope, anterior instability, and postoperative complication.ResultsThere were no limitations in range of motion found in any cases. Three patients showed progressive osteoarthritis on the medial compartment. The mechanical femorotibial angle was significantly corrected from varus 7.0 degrees to valgus 1.2 degrees, and the tibial posterior slope was not significantly changed. The Lysholm and Tegner activity scores were significantly improved after surgery (from 58 to 94 points on the Lysholm scale and from 4.0 to 5.3 points on the Tegner activity scale). Although the Lachman test and the pivot-shift test showed significant improvements after surgery, instability greater than Gr II was observed in three patients on the Lachman test and in four patients on the pivot-shift test. The side-to-side difference improved from 9.6 mm to 4.2 mm postoperatively as assessed using a Telos® arthrometer. There were no cases of nonunion or fixation loss.ConclusionsSimultaneous open-wedge HTO and ACL reconstruction in patients with ACL injury with medial compartmental OA showed satisfactory functional outcomes and postoperative activity level scores. However, some patients showed residual instability and progression of OA.

Project description:Anterior cruciate ligament (ACL) deficiency alters 6 degrees of freedom knee kinematics, yet only anterior translation and internal rotation have been the primary measures in previous studies.To compare the 6 degrees of freedom knee kinematics and the graft forces after single- and double-bundle ACL reconstructions under various external loading conditions.Controlled laboratory study.Ten human cadaveric knees were tested with a robotic testing system under 4 conditions: intact, ACL deficient, single-bundle reconstructed with a quadrupled hamstring tendon graft, and double-bundle reconstructed with 2 looped hamstring tendon grafts. Knee kinematics and forces of the ACL or ACL graft in each knee were measured under 3 loading conditions: an anterior tibial load of 134 N, a simulated quadriceps muscle load of 400 N, and combined tibial torques (10 N.m valgus and 5 N.m internal tibial torques) at 0 degrees , 15 degrees , 30 degrees , 60 degrees , and 90 degrees of knee flexion.The double-bundle reconstruction restored the anterior and medial laxities closer to the intact knee than the single-bundle reconstruction. However, the internal rotation of the tibia under the simulated quadriceps muscle load was significantly decreased when compared with the intact knee after both reconstructions, more so after double-bundle reconstruction (P < .05). The entire graft force of the double-bundle reconstruction was more similar to that of the intact ACL than that of the single-bundle reconstruction. However, the posterolateral bundle graft in the double-bundle reconstructed knee was overloaded as compared with the intact posterolateral bundle.The double-bundle reconstruction can better restore the normal anterior-posterior and medial-lateral laxities than the single-bundle reconstruction can, but an overloading of the posterolateral bundle graft can occur in a double-bundle reconstructed knee.Both single-bundle and double-bundle techniques cannot restore the rotational laxities and the ACL force distributions of the intact knee.

Project description:PurposeThe research objective of this study is to use finite element analysis to investigate the impact of anterior cruciate ligament (ACL) injury on medial unicompartmental knee arthroplasty (UKA) and explore whether patients with ACL injuries can undergo UKA.MethodsBased on the morphology of the ACL, models of ACL with diameters ranging from 1 to 10mm are created. Finite element models of UKA include ACL absence and ACLs with different diameters. After creating a complete finite element model and validating it, four different types of loads are applied to the knee joint. Statistical analysis is conducted to assess the stress variations in the knee joint structure.ResultsA total of 11 finite element models of UKA were established. Regarding the stress on the ACL, as the diameter of the ACL increased, when a vertical load of 750N was applied to the femur, combined with an anterior tibial load of 105N, the stress on the ACL increased from 2.61 MPa to 4.62 MPa, representing a 77.05% increase. Regarding the equivalent stress on the polyethylene gasket, a notable high stress change was observed. The stress on the gasket remained between 12.68 MPa and 14.33 MPa in all models. the stress on the gasket demonstrated a decreasing trend. The equivalent stress in the lateral meniscus and lateral femoral cartilage decreases, reducing from the maximum stress of 4.71 MPa to 2.61 MPa, with a mean value of 3.73 MPa. This represents a reduction of 44.72%, and the statistical significance is (P < 0.05). However, under the other three loads, there was no significant statistical significance (P > 0.05).ConclusionThis study suggests that the integrity of the ACL plays a protective role in performing medial UKA. However, this protective effect is limited when performing medial UKA. When the knee joint only has varying degrees of ACL injury, even ACL rupture, and the remaining structures of the knee joint are intact with anterior-posterior stability in the knee joint, it should not be considered a contraindication for medial UKA.

Dataset Information

Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years.

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Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years.

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