title: Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial.
abstract: BACKGROUND
  The reported prevalence of radiological osteoarthritis (OA) after anterior cruciate ligament (ACL) reconstruction varies from 10% to 90%. Purpose/
  
  
  OBJECTIVE
  To report the prevalence of OA after ACL reconstruction and to compare the OA prevalence between quadrupled semitendinosus tendon (ST) and bone-patellar tendon-bone (BPTB) grafts. The hypothesis was that there would be no difference in OA prevalence between the graft types. The secondary aim was to study whether patient characteristics and additional injuries were associated with long-term outcomes.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 1.
  
  
  METHODS
  Radiological examination results, Tegner activity levels, and Knee injury and Osteoarthritis Outcome Score (KOOS) values were determined in 135 (82%) of 164 patients at a mean of 14 years after ACL reconstruction randomized to an ST or a BPTB graft. Osteoarthritis was defined according to a consensus by at least 2 of 3 radiologists of Kellgren-Lawrence grade ≥2. Using regression analysis, graft type, sex, age, overweight, time between injury and reconstruction, additional meniscus injury, and a number of other variables were assessed as risk factors for OA 14 years after ACL reconstruction.
  
  
  RESULTS
  Osteoarthritis of the medial compartment was most frequent, with 57% of OA cases in the ACL-reconstructed knee and 18% of OA cases in the contralateral knee (P < .001). There was no difference between the graft types: 49% of OA of the medial compartment for BPTB grafts and 65% for ST grafts (P = .073). The KOOS results were lower for patients with OA in all subscales, indicating that OA was symptomatic. No difference in the KOOS between the graft types was found. Meniscus resection was a strong risk factor for OA of the medial compartment (odds ratio, 3.6; 95% CI, 1.4-9.3) in the multivariable logistic regression analysis.
  
  
  CONCLUSIONS
  A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee. No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found. An initial meniscus resection was a strong risk factor for OA; the time between injury and reconstruction was not.
authors.affiliation: Björn Barenius, Orthopaedics Section, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE-118 83 Stockholm, Sweden. bjorn.barenius@sodersjukhuset.se.
authors.forename: Björn
authors.initials: B
authors.lastname: Barenius
authors.forename: Sari
authors.initials: S
authors.lastname: Ponzer
authors.forename: Adel
authors.initials: A
authors.lastname: Shalabi
authors.forename: Robert
authors.initials: R
authors.lastname: Bujak
authors.forename: Louise
authors.initials: L
authors.lastname: Norlén
authors.forename: Karl
authors.initials: K
authors.lastname: Eriksson
mesh_terms: D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000009:adverse effects* / Q000379:methods; D015992:Body Mass Index; D050376:Bone-Patellar Tendon-Bone Grafting; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D015999:Multivariate Analysis; D020370:Osteoarthritis, Knee / Q000000981:diagnostic imaging / Q000209:etiology*; D015995:Prevalence; D011859:Radiography; D012307:Risk Factors; D013710:Tendons / Q000637:transplantation*; D064232:Visual Analog Scale; D055815:Young Adult
keywords: ACL reconstruction; long-term follow-up; osteoarthritis; patellar tendon graft; semitendinosus tendon graft