Abstract
Objective: To identify the consequences of an anterior cruciate ligament (ACL) tear in a cohort of male soccer players 14 years after the initial injury with respect to radiographic knee osteoarthritis and patient relevant outcomes.
Methods: Of 219 male soccer players with an ACL injury in 1986, 205 (94%) were available for follow up after 14 years; 75% of the cohort (154/205) answered mailed questionnaires (KOOS, SF-36, and Lysholm knee scoring scale) and 122 of these consented to weight bearing radiographs.
Results: Radiographic changes were found in 95 (78%) of the injured knees, while more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in 50 (41%). In the uninjured knees more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in five knees (4%). No differences were seen between surgically and conservatively treated players. The patient relevant outcome was affected and did not differ between subjects with and without radiographic changes. Eighty per cent reported reduced activity level.
Conclusions: A high prevalence of radiographic knee osteoarthritis was seen in male soccer players 14 years after an ACL disruption. The injury and the osteoarthritis, irrespective of the treatment provided to these patients, often result in knee related symptoms that severely affect the knee related quality of life by middle age.
Full Text
The Full Text of this article is available as a PDF (191.0 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Altman R. D., Hochberg M., Murphy W. A., Jr, Wolfe F., Lequesne M. Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage. 1995 Sep;3 (Suppl A):3–70. [PubMed] [Google Scholar]
- Arendt E., Dick R. Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. 1995 Nov-Dec;23(6):694–701. doi: 10.1177/036354659502300611. [DOI] [PubMed] [Google Scholar]
- Arnason A., Gudmundsson A., Dahl H. A., Jóhannsson E. Soccer injuries in Iceland. Scand J Med Sci Sports. 1996 Feb;6(1):40–45. doi: 10.1111/j.1600-0838.1996.tb00069.x. [DOI] [PubMed] [Google Scholar]
- Bellamy N., Buchanan W. W., Goldsmith C. H., Campbell J., Stitt L. W. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988 Dec;15(12):1833–1840. [PubMed] [Google Scholar]
- Carr A. J. Beyond disability: measuring the social and personal consequences of osteoarthritis. Osteoarthritis Cartilage. 1999 Mar;7(2):230–238. doi: 10.1053/joca.1998.0154. [DOI] [PubMed] [Google Scholar]
- Cooper C., Snow S., McAlindon T. E., Kellingray S., Stuart B., Coggon D., Dieppe P. A. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum. 2000 May;43(5):995–1000. doi: 10.1002/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1. [DOI] [PubMed] [Google Scholar]
- Daniel D. M., Stone M. L., Dobson B. E., Fithian D. C., Rossman D. J., Kaufman K. R. Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med. 1994 Sep-Oct;22(5):632–644. doi: 10.1177/036354659402200511. [DOI] [PubMed] [Google Scholar]
- Demirdjian A. M., Petrie S. G., Guanche C. A., Thomas K. A. The outcomes of two knee scoring questionnaires in a normal population. Am J Sports Med. 1998 Jan-Feb;26(1):46–51. doi: 10.1177/03635465980260012401. [DOI] [PubMed] [Google Scholar]
- Englund M., Roos E. M., Lohmander L. S. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. Arthritis Rheum. 2003 Aug;48(8):2178–2187. doi: 10.1002/art.11088. [DOI] [PubMed] [Google Scholar]
- Engström B., Johansson C., Törnkvist H. Soccer injuries among elite female players. Am J Sports Med. 1991 Jul-Aug;19(4):372–375. doi: 10.1177/036354659101900408. [DOI] [PubMed] [Google Scholar]
- Felson D. T., Lawrence R. C., Dieppe P. A., Hirsch R., Helmick C. G., Jordan J. M., Kington R. S., Lane N. E., Nevitt M. C., Zhang Y. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000 Oct 17;133(8):635–646. doi: 10.7326/0003-4819-133-8-200010170-00016. [DOI] [PubMed] [Google Scholar]
- Felson D. T. The course of osteoarthritis and factors that affect it. Rheum Dis Clin North Am. 1993 Aug;19(3):607–615. [PubMed] [Google Scholar]
- Ferretti A., Conteduca F., De Carli A., Fontana M., Mariani P. P. Osteoarthritis of the knee after ACL reconstruction. Int Orthop. 1991;15(4):367–371. doi: 10.1007/BF00186881. [DOI] [PubMed] [Google Scholar]
- Gelber A. C., Hochberg M. C., Mead L. A., Wang N. Y., Wigley F. M., Klag M. J. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med. 2000 Sep 5;133(5):321–328. doi: 10.7326/0003-4819-133-5-200009050-00007. [DOI] [PubMed] [Google Scholar]
- Graham G. P., Fairclough J. A. Early osteoarthritis in young sportsmen with severe anterolateral instability of the knee. Injury. 1988 Jul;19(4):247–248. doi: 10.1016/0020-1383(88)90037-x. [DOI] [PubMed] [Google Scholar]
- Hernborg J., Nilsson B. E. Age and sex incidence of osteophytes in the knee joint. Acta Orthop Scand. 1973;44(1):66–68. doi: 10.3109/17453677308988674. [DOI] [PubMed] [Google Scholar]
- KELLGREN J. H., LAWRENCE J. S. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494–502. doi: 10.1136/ard.16.4.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Kannus P., Järvinen M. Age, overweight, sex, and knee instability: their relationship to the post-traumatic osteoarthrosis of the knee joint. Injury. 1988 Mar;19(2):105–108. doi: 10.1016/0020-1383(88)90084-8. [DOI] [PubMed] [Google Scholar]
- Kohatsu N. D., Schurman D. J. Risk factors for the development of osteoarthrosis of the knee. Clin Orthop Relat Res. 1990 Dec;(261):242–246. [PubMed] [Google Scholar]
- Kujala U. M., Kaprio J., Sarna S. Osteoarthritis of weight bearing joints of lower limbs in former élite male athletes. BMJ. 1994 Jan 22;308(6923):231–234. doi: 10.1136/bmj.308.6923.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Neyret P., Donell S. T., DeJour D., DeJour H. Partial meniscectomy and anterior cruciate ligament rupture in soccer players. A study with a minimum 20-year followup. Am J Sports Med. 1993 May-Jun;21(3):455–460. doi: 10.1177/036354659302100322. [DOI] [PubMed] [Google Scholar]
- Roos E. M., Roos H. P., Ekdahl C., Lohmander L. S. Knee injury and Osteoarthritis Outcome Score (KOOS)--validation of a Swedish version. Scand J Med Sci Sports. 1998 Dec;8(6):439–448. doi: 10.1111/j.1600-0838.1998.tb00465.x. [DOI] [PubMed] [Google Scholar]
- Roos E. M., Roos H. P., Lohmander L. S., Ekdahl C., Beynnon B. D. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther. 1998 Aug;28(2):88–96. doi: 10.2519/jospt.1998.28.2.88. [DOI] [PubMed] [Google Scholar]
- Roos H., Adalberth T., Dahlberg L., Lohmander L. S. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage. 1995 Dec;3(4):261–267. doi: 10.1016/s1063-4584(05)80017-2. [DOI] [PubMed] [Google Scholar]
- Roos H., Laurén M., Adalberth T., Roos E. M., Jonsson K., Lohmander L. S. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998 Apr;41(4):687–693. doi: 10.1002/1529-0131(199804)41:4<687::AID-ART16>3.0.CO;2-2. [DOI] [PubMed] [Google Scholar]
- Roos H., Lindberg H., Gärdsell P., Lohmander L. S., Wingstrand H. The prevalence of gonarthrosis and its relation to meniscectomy in former soccer players. Am J Sports Med. 1994 Mar-Apr;22(2):219–222. doi: 10.1177/036354659402200211. [DOI] [PubMed] [Google Scholar]
- Roos H., Ornell M., Gärdsell P., Lohmander L. S., Lindstrand A. Soccer after anterior cruciate ligament injury--an incompatible combination? A national survey of incidence and risk factors and a 7-year follow-up of 310 players. Acta Orthop Scand. 1995 Apr;66(2):107–112. doi: 10.3109/17453679508995501. [DOI] [PubMed] [Google Scholar]
- Sandmark H., Vingård E. Sports and risk for severe osteoarthrosis of the knee. Scand J Med Sci Sports. 1999 Oct;9(5):279–284. doi: 10.1111/j.1600-0838.1999.tb00246.x. [DOI] [PubMed] [Google Scholar]
- Segawa H., Omori G., Koga Y. Long-term results of non-operative treatment of anterior cruciate ligament injury. Knee. 2001 Mar;8(1):5–11. doi: 10.1016/s0968-0160(00)00062-4. [DOI] [PubMed] [Google Scholar]
- Shapiro E. T., Richmond J. C., Rockett S. E., McGrath M. M., Donaldson W. R. The use of a generic, patient-based health assessment (SF-36) for evaluation of patients with anterior cruciate ligament injuries. Am J Sports Med. 1996 Mar-Apr;24(2):196–200. doi: 10.1177/036354659602400214. [DOI] [PubMed] [Google Scholar]
- Shelbourne K. D., Gray T. Results of anterior cruciate ligament reconstruction based on meniscus and articular cartilage status at the time of surgery. Five- to fifteen-year evaluations. Am J Sports Med. 2000 Jul-Aug;28(4):446–452. doi: 10.1177/03635465000280040201. [DOI] [PubMed] [Google Scholar]
- Sherman M. F., Warren R. F., Marshall J. L., Savatsky G. J. A clinical and radiographical analysis of 127 anterior cruciate insufficient knees. Clin Orthop Relat Res. 1988 Feb;227:229–237. [PubMed] [Google Scholar]
- Sullivan M., Karlsson J., Ware J. E., Jr The Swedish SF-36 Health Survey--I. Evaluation of data quality, scaling assumptions, reliability and construct validity across general populations in Sweden. Soc Sci Med. 1995 Nov;41(10):1349–1358. doi: 10.1016/0277-9536(95)00125-q. [DOI] [PubMed] [Google Scholar]
- Tegner Y., Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res. 1985 Sep;(198):43–49. [PubMed] [Google Scholar]
- Wu W. Howard, Hackett Thomas, Richmond John C. Effects of meniscal and articular surface status on knee stability, function, and symptoms after anterior cruciate ligament reconstruction: a long-term prospective study. Am J Sports Med. 2002 Nov-Dec;30(6):845–850. doi: 10.1177/03635465020300061501. [DOI] [PubMed] [Google Scholar]