Although osteoarthritis (OA) of the tibiofemoral joint is typically the focus after ACL rupture, radiographic OA affects the patellofemoral joint in approximately half of patients 10 years after ACL injury. Patellofemoral OA may even be more common than tibiofemoral OA and is associated with worse symptoms.
The MRIs of 117 ACL injuries were evaluated at baseline and at 2 and 5 years post-injury to determine patellar, trochlear and total patellofemoral cartilage thickness changes. Comparisons were made between as-randomised and as-treated groups according to whether early or optional delayed ACLR was performed.
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.
