I would like to comment on the article by J.K. Seon et al. entitled “Osteoarthritis after anterior cruciate ligament reconstruction using apatellar tendon autograft” [4]. The authors investigated the development of osteoarthritis (OA) in patients who had their ACLs reconstructed using patellar tendon autograft. They determined the risk factors of OA to be: patient age over 25 years at the time of the operation, an interval between the injury and reconstruction of greater than 6 months, and additional meniscal injury [4].
As the follow-up period was long, we would like to know if the patients gained weight during follow-up, because weight increase affects the development of OA independently of the surgical procedure. The importance of increased weight and patient education has been reported previously [5].
The authors found no correlation between anterior instability or persistent subluxation and the developmentof OA in the long-term follow-up [4]. There are studies with much longer follow-ups that demonstrate that these factors increase the cartilage damage and thus osteoarthritis, making these people candidates for total knee replacement [1].
In a recent study, it was reported that the decrease of patellar tendon stiffness causes a decrease in bone mineral content and increases OA in patients who had undergone ACL reconstruction using patellar tendon allograft [2].
Although reconstructions using patellar tendon autograft and hamstring autograft gave similar clinical results, patellar tendon autograft is found to pose a greater risk of early development of OA [3].
In conclusion, although additional meniscal lesions, age and late reconstruction were blamed, patellar tendon autograft and an increase in weight are independent risk factors for osteoarthritis following ACL reconstruction.
Footnotes
This comment refers to the article available at:http://dx.doi.org/10.1007/s00264-005-0036-0
References
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