Midterm radiographic osteoarthritis associated with ACL reconstruction: Comparison with the contralateral knee and association with meniscal status, age, and surgical delay
Hisham M. Gawish, Mohamed I. Shoughy, Ahmed R. Elzeiny, Hany M. Hamed, Hossam M. Gad, Hatem E. ElgoharyObjectives:
Anterior cruciate ligament reconstruction (ACLR) restores knee stability, but its long-term effect on preventing post-traumatic osteoarthritis (OA) remains unclear. This study evaluated the midterm risk of radiographic knee OA after ACLR by comparing the operated knee with its preoperative status and the contralateral knee, in association with meniscal status, age, and surgical delay.
Methods:
Retrospective cross-sectional study of 108 patients (mean age 30.7 years; mean follow-up 7.1 years) who underwent hamstring ACLR. The operated knee was compared with its preoperative status and the contralateral knee using the Kellgren–Lawrence (KL) grading system. Clinical assessment included Lysholm score, kinesiophobia scale, and objective laxity testing; independent predictors were identified using multivariable ordinal logistic regression.
Results:
Moderate-to-severe OA (KL grades 3–4) was present in 25.9% of operated knees at midterm follow-up, vs. none preoperatively and 3.7% of contralateral knees (interobserver κ = 0.986). Partial meniscectomy showed the highest severity, with 75% developing KL grades 3–4. Age, follow-up duration, knee laxity, and meniscectomy were independent predictors of OA grade on multivariable analysis; surgical delay was associated with OA severity univariately but not after adjustment. OA grade correlated negatively with Lysholm score (r = –0.594, p < 0.001) and positively with kinesiophobia (r = 0.421, p = 0.002) and laxity (r = 0.354, p = 0.009).
Conclusion:
ACLR does not fully prevent post-traumatic OA: About one-quarter of patients developed moderate-to-severe radiographic changes at midterm follow-up despite an OA-free preoperative baseline. Advanced age, follow-up duration, knee laxity, and meniscectomy are independent risk factors; surgical delay shows a univariate association.