Loss of patellofemoral cartilage 5 years after ACL injury

...are there differences depending on treatment strategy?

This study found patellofemoral cartilage thickness loss in young adults following acute anterior cruciate ligament (ACL) rupture.

A greater loss was seen in subjects randomised to early ACL reconstruction (ACLR) and rehabilitation than in those receiving optional delayed ACLR and rehabilitation.

This difference was present at both two and five years after injury. The greatest decrease occurred in the trochlea during the first two years.

Early ACLR may be associated with greater short-term patellofemoral cartilage deterioration and seems therefore unable to prevent structural changes.

This means early ACLR does not seem to be indicated in terms of patellofemoral pathology.

The difference was irrespective of the graft type used, but was only seen in the as-randomised comparisons and not between as-treated groups.

> From: Culvenor et al., Br J Sports Med 53 (2019) 1168-1173 . All rights reserved to The Author(s). Click here for the online summary.

Expert opinion

This study adds to a recent trend, which shows a lack of scientific support for early surgical treatment in a multitude of orthopaedic conditions, especially in long-term outcomes.

These results are even more relevant given that ACLR is still frequently seen as the only option for young active individuals after ACL injury.

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