M. Haberfield1, B. Patterson1, K. Crossley1, A. Bruder1, A. Guermazi2, T. Whitehead3, H. Morris4, A. Culvenor1
1La Trobe University, Sports and Exercise Medicine, Melbourne, Australia, 2Boston University, Department of Radiology, Boston, United States, 3Ortho Sport Victoria, Melbourne, Australia, 4Park Clinic Orthopaedics, Melbourne, Australia
Background: Knee joint injury accounts for approximately 10% of the overall prevalence of symptomatic knee osteoarthritis (OA). Anterior cruciate ligament (ACL) rupture contributes to most posttraumatic knee OA cases, evident decades earlier than nontraumatic OA. The well-defined initiating event means that individuals who suffer an ACL rupture represent an easily identifiable ‘at risk’ group to implement secondary OA prevention. Returning to high-impact pivoting sport following ACL rupture and reconstruction (ACLR) represents a potential modifiable factor. Given that surgical success is often judged on a return to pivoting sport, previous conflicting findings highlight the need to investigate the influence of returning to pivoting sport after ACLR on the risk of longitudinal structural OA changes and knee symptoms.
Purpose: To evaluate if returning to pivoting sport following ACLR is associated with structural and symptomatic osteoarthritis outcomes.
Methods: Eighty-one adults aged 18-50 years were followed prospectively 1- to 5-years post-ACLR. Return to pivoting sport was assessed at 1-, 3- and 5-years. Longitudinal changes in osteoarthritis features were evaluated between 1- and 5-year from MRIs using the MRI Osteoarthritis Knee Score (MOAKS). Radiographic osteoarthritis and self-reported knee symptoms, function and quality of life were assessed using the OARSI atlas and Knee injury Osteoarthritis Outcome Score (KOOS), respectively, at 5 years post-ACLR. Generalised linear models (adjusted for baseline characteristics) assessed whether returning to pivoting sport was associated with risk of worsening osteoarthritis features on MRI, radiographic osteoarthritis and KOOS.
Results: Thirty participants returned to pivoting sport 1-year post-ACLR and 50 returned at any time (i.e., 1-, 3- or 5-years). Returning to pivoting sport was not associated with worsening of any MRI osteoarthritis feature (risk ratio (RR) range:0.59–2.91) or 5-year KOOS (β range:-2.73–3.69). Returning to pivoting sport at 1-year and up to 5-years post-ACLR was associated with a 50% (RR 0.49, 95%CI 0.10–2.37) and 40% (RR 0.60, 95%CI 0.16–2.17) reduced risk of radiographic osteoarthritis, respectively, but these risk reductions were inconclusive due to wide confidence intervals.
Conclusion(s): Returning to pivoting sport following ACLR was not associated with increased risk of worsening knee osteoarthritis features on MRI, radiographic osteoarthritis or knee symptoms. Participation in pivoting sport need not be avoided as part of osteoarthritis secondary prevention strategies.
Implications: Our results provide reassurance for clinicians and patients who may be concerned about a return to pivoting sport after ACLR increasing the risk of osteoarthritis. In the context of secondary prevention of structural osteoarthritis, a return to pivoting sport need not be avoided.
Funding, acknowledgements: Brooke Patterson, Adam Culvenor are recipients of National Health and Medical Research Council awards
Keywords: Return to Sport, Knee injury, Magnetic resonance imaging
Topic: Sport & sports injuries
Did this work require ethics approval? Yes
Institution: La Trobe University
Committee: La Trobe University Human Ethics Committee
Ethics number: HEC 15-100
All authors, affiliations and abstracts have been published as submitted.
