Does ACL-reconstruction prevent early OA?. Ejnar Eriksson, M.D. Karolinska Institute, Stockholm, Sweden. Does ACL-reconstr. prevent OA?. This is a highly debated subject! I wish I could give you a true and definitive answer. No consensus! So unfortunately, we still do not
Ejnar Eriksson, M.D.
This is a highly debated subject!
I wish I could give you a true and
definitive answer. No consensus!
So unfortunately, we still do not
know the answer to this question.
I will give you some information that
might give you a little “food for
joint cartilage lacks
blood supply and
receives its nutrition
from the joint fluid.
The cartilage acts
like a sponge – when
compressed, fluid is
squeezed out and
(during walking or
running) it sucks up
nutritious joint fluid.
arthritis in a rabbit
joint – is to immobilize
the joint in a cast.
time you have
sports ought to be
very good for our
joints. During running
we regularly load
and unload our joints.
This ought to improve
the nutrition of the
cartilage of our
joints a lot.
50-year old football
players with horrible
arthrosis after an
in this guy??
..or young football players
like these two in their
20-ies with severe cartilage
The explanation for their
cartilage injuries is :
27 years old
..that it is not the sport per se – the cartilage damage is caused by the injuries that the players have sustained!!
An ACL-reconstruction would of course
stabilize the knee and could prevent further
dangerous pivot shifts.
But if the cartilage damage is already there,
an ACL reconstruction could only possibly
stop further cartilage damage.
The only way to find out more about this, is
to search the literature…
Andersson, Odensten, Gillquist, 1991 (but they compared repair (+possible augmentation) with non-op treatment.
Will reconstructive ACL-surgery increase
or decrease the risk of OA after an ACL injury? Let’s look at the literature.
Review, 50% OA after 15 ys
Soccer players, surg. treated
77% OA after 20 ys
Non op treated, 12 ys,
37% JSN, 63% OA-changes
42-46 % OA 8 years after
ACL injuries in handball
42% and 48% OA, 12-14 ys
16 % after 15 ys, 0% if no
meniscus injury in non-op.
the development of arthrosis
Fink et al, ESSKA 2006
Kessler et al. ESSKA 2006
development of arthrosis
Increase of arthrosis after ACL-reconstruction
The group in Lund, Sweden with Harald Roos and Stefan Lohmander maintains that football players with ACL-injuries get arthrosis whether operated or not.
This is a hot subject today. In Lund they are therefore right now making a propspective randomised study of ACL-reconstruction versus non-operative treatment of ACL.
development of arthrosis
Positive effect of ACL-reconstruction
Karl-Peter Benedetto and his group from Innsbruck
saw less arthrosis after surgery than in non-op cases
studies by Lohmander and his group
in Lund, Sweden, that all injuries
to a joint lead to release of harmful
cytokines, that remain for quite a
time and can cause cartilage damage.
body adenosine A2a is the mechanism by which the
body controls inflammatory joint-phenomena…
If this holds true in larger controlled studies
with longer follow-ups, maybe we could stop
the cartilage damage caused by cytokines after
injuries or surgery. I have actually written…
Between 1968 and 1972, we operated 134
patellar tendon ACL-reconstructions at
the Karolinska Hospital in Stockholm.
In 1978, a young Robert J Johnson from
Burlington, Vermont, USA came to Stockholm
to follow up 84 of them after 5-10 years…
These patients are now 35-40 years post
surgery. We have therefore invited Bob
Johnson to come back to Stockholm and
re-examine the same cases.
One leg jump
All the 86 we have studied so far have
undergone X-ray and motion MRI.
Unfortunately many of these patients
had already had a meniscectomy before
5-10 years after the ACL-reconstruction,
Bob Johnson did not find any difference in
arthrosis between the guys without
menisci and the ones with intact menisci.
35 years later, the ones without menisci all have had a knee replacement or are waiting for one due to severe degenerative arthrosis.
The ones with intact menisci and stable knees, are surprisingly good, though.
These guys have been able
to do pivoting sports ever since
their surgery. They are now
in their 60-ies and very satisfied
with the operation.
They do not have more arthrosis
in the operated knee than in their
healthy control knee.
On motion MRI – one can see a normal-looking ACL that resists anterior drawer.
Our study is not completed yet. But we already now can say that the “late”
arthrosis evidently depends very
much on absence of their menisci.
The reason for performing an ACL-reconstruction thus seems to be to protect the menisci. Hogervorst found the same
in his 2002 study like Meunier et al. in their 15 yr follow-up, 2007.
But note this is for prevention of late osteoarthrosis.
But your question to me was:
Does ACL-reconstruction prevent
Let me therefore tell you the story of a
young football player some 20 years ago.
He came after an acute pivot-shift and
One can easily understand
why such injuries lead to
degenerative arthrosis in
the future. In this case,
it is questionable if an
prevent early osteoarthrosis.
I am sorry that I have not been able to
give a clear-cut answer to your question.
I hope, however, that I have given you
some food for thoughts…
If you need an excuse for coming to beautiful
Stockholm in September this year, we are
arranging a fantastic conference then…
If you like downhill
skiing and Italian
pasta – why not join me
and the top faculty in
in Italy Jan. 13-18, 2008.
Our course always
receives high points
from the participants..
your kind attention