Knee osteoarthritis after anterior cruciate ligament reconstruction: Prevalence, contributing factors and new interventions to alter the course of degeneration

Fifty percent of patients who undergo an anterior cruciate ligament reconstruction (ACLR) experience knee osteoarthritis 12–14 years later. Factors that can contribute to the development of osteoarthritis after ACLR are abnormal anterior tibial displacement and abnormal tibial rotation during the stance phase of walking (present in 85% of operated knees). Patients who experience an early ACLR (5 days on average after anterior cruciate ligament [ACL] rupture) have a lower prevalence of radiographically evident tibiofemoral osteoarthritis at 32–37 years of follow-up than patients with ACL who did not undergo the operation. However, the rate of symptomatic osteoarthritis, radiographically evident patellofemoral osteoarthritis and knee symptoms are similar in both groups. At 15 years of follow-up, 23% of knees that underwent an anatomic ACLR experience osteoarthritis, while this rate increases to 44% if the ACLR was non-anatomic. Knees of patients who undergo ACLR require total knee arthroplasty at an earlier age than healthy knees. Intra-articular injections of interleukin-1 receptor antagonist and corticosteroids might decrease the risk of osteoarthritis after ACLR.