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Title: Accelerated return to sport after anterior cruciate ligament reconstruction and early knee osteoarthritis features at 1 year: an exploratory study.
Authors: Whitehead, Timothy
Other Authors: Culvenor, Adam
Patterson, Brooke
Guermazi, Ali
Morris, Hayden
Crossley, Kay
Keywords: Anterior Cruciate Ligament Reconstruction
Knee Osteoarthritis
Magnetic Resonance Imaging
Lower Limb Function
Bone Marrow Lesions
Meniscal Lesions
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Sep-2017
Publisher: Elsevier
Citation: PM R. 2017 Sep 14. pii: S1934-1482(17)30043-6
Abstract: BACKGROUND: A timely return to competitive sport is a primary goal of anterior cruciate ligament reconstruction (ACLR). It is not known whether an accelerated return to sport increases the risk of early-onset knee osteoarthritis (KOA). OBJECTIVE: To determine whether an accelerated return to sport post-ACLR (ie, <10 months) is associated with increased odds of early KOA features on magnetic resonance imaging (MRI) 1 year after surgery and to evaluate the relationship between an accelerated return to sport and early KOA features stratified by type of ACL injury (isolated or concurrent chondral/meniscal injury) and lower limb function (good or poor). DESIGN: Cross-sectional study. SETTING: Private radiology clinic and university laboratory. PARTICIPANTS: A total of 111 participants (71 male; mean age 30 ± 8 years) 1-year post-ACLR. METHODS: Participants completed a self-report questionnaire regarding postoperative return-to-sport data (specific sport, postoperative month first returned), and isotropic 3-T MRI scans were obtained. OUTCOME MEASURES: Early KOA features (bone marrow, cartilage and meniscal lesions, and osteophytes) assessed with the MRI OA Knee Score. Logistic regression analyses evaluated the odds of early KOA features with an accelerated return to sport (<10 months post-ACLR versus ≥10 months or no return to sport) in the total cohort and stratified by type of ACL injury and lower limb function. RESULTS: Forty-six (41%) participants returned to competitive sport <10 months post-ACLR. An early return to sport was associated with significantly increased odds of bone marrow lesions (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-6.0) but not cartilage (OR 1.2, 95% CI 0.5-2.6) or meniscal lesions (OR 0.8, 95% CI 0.4-1.8) or osteophytes (OR 0.6, 95% CI 0.3-1.4). In those with poor lower limb function, early return to sport exacerbated the odds of bone marrow lesions (OR 4.6, 95% CI 1.6-13.5), whereas stratified analyses for type of ACL injury did not reach statistical significance. CONCLUSION: An accelerated return to sport, particularly in the presence of poor lower limb function, may be implicated in posttraumatic KOA development. LEVEL OF EVIDENCE: III.
DOI: 10.1016/j.pmrj.2017.09.005
PubMed URL:
ISSN: 1934-1482
Journal Title: PM&R: The Journal of Injury, Function, and Rehabilitation
Type: Journal Article
Affiliated Organisations: Institute of Anatomy, Paracelsus Medical University, Strubergasse 21, Salzburg 5020, Austria
La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia
Quantitative Imaging Centre, Department of Radiology, Boston University School of Medicine, Boston, MA
The Park Clinic, St Vincent's Private Hospital, Melbourne, Australia
Type of Clinical Study or Trial: Cross-Sectional Study
Appears in Collections:Musculoskeletal

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