Osteoarthritis and cartilage | 2021
Early anterior cruciate ligament reconstruction does not affect five year change in knee cartilage thickness: Secondary analysis of a randomized clinical trial.
Abstract
OBJECTIVE\nTo compare five-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.\n\n\nDESIGN\n62 patients were randomized to early ACLR, 59 to optional delayed ACLR. MRI was acquired within four weeks of injury, at two- and five-years follow-up. Main outcome was five-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.\n\n\nRESULTS\nBaseline and at least one follow-up MRI were available for 117 patients. Over five 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: -5μm, 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: 403μm [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: 632μm [268, 996]μm) or delayed ACLR (adjusted mean difference: 449μm [108, 791]μm) than for patients treated with rehabilitation alone.\n\n\nCONCLUSIONS\nIn young active adults with acute ACL-injury, choice of treatment strategy for the injured ACL did not modify the magnitude of five-year change in overall femorotibial cartilage thickness.\n\n\nTRIAL REGISTRATION\nISRCTN84752559.