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Das zeitabhängige Arthroserisiko nach vorderer Kreuzbandverletzung

Ergebnisse einer systematischen Literaturrecherche

The time-related risk for knee osteoarthritis after ACL injury

Results from a systematic review

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Zusammenfassung

Zielstellung

Anliegen der hier vorgelegten systematischen Literaturrecherche mit anschließender Metaanalyse war es, den zeitlichen Verlauf der Entstehung einer Gonarthrose nach vorderer Kreuzbandverletzung darzustellen und zu ermitteln.

Methode

Mit Stichtag 01.12.2014 wurde auf mehreren Datenbanken nach der Suchstrategie [ACL] AND [osteoarthritis] recherchiert. Von den primär gefundenen 1656 infrage kommenden Arbeiten wählten zwei Gutachter 140 Publikationen zur Volltextlesung aus. Schließlich wurden insgesamt 21 relevante Arbeiten identifiziert.

Ergebnisse

Die Arthroserate nach Kreuzbandverletzung nimmt mit dem Zeitintervall signifikant zu. Nach zwei Jahren beträgt sie 6,9 %, nach fünf Jahren 32,2 %, nach sieben Jahren 36,3 % und nach zehn Jahren 79,6 %. Gleichzeitig steigt mit zunehmendem Zeitintervall nach der Verletzung auch der Schweregrad der radiologischen Gonarthrose.

Das relative Arthroserisiko nach Kreuzbandverletzung erhöht sich bereits nach zwei Jahren um etwa das Doppelte. Nach sieben Jahren erhöht es sich auf etwa das 5-fache und verglichen mit dem Arthrosestatus zum Zeitpunkt der Verletzung nach zehn Jahren nochmals signifikant.

Schlussfolgerungen

Die Verletzung des vorderen Kreuzbandes stellt einen erwiesenen Risikofaktor für eine spätere, dem Altersdurchschnitt vorangehende Arthroseentwicklung dar. Bereits innerhalb der ersten fünf Jahre nach der Verletzung lassen sich in den bildgebenden Verfahren (Röntgen, Kernspintomografie) Zeichen einer zunehmenden Arthroseentwicklung nachweisen. Allerdings haben diese Veränderungen in der Regel für die Betroffenen Patienten noch keinen direkten Krankheitswert. Erst ab dem achten Jahr nach Verletzung kommt es zu einem deutlichen Anstieg der Arthroseraten höherer Schweregrade und damit zur Behandlungsbedürftigkeit der Gonarthrose.

Abstract

Aim

The aim of this review was to evaluate the time-related risk for knee osteoarthritis in patients after ACL injury.

Materials and methods

The primary search was carried out in different medical databases with the deadline 12.01.2014. The search strategy for the evaluation was [ACL] AND [osteoarthritis] including “all fields”. All 1656 title/abstracts were reviewed by two independent researchers who selected 140 papers for full text review. Finally, a total of 21 relevant publications were identified for inclusion in this current paper.

Results

The incidence of knee osteoarthritis rises significantly over time. Two years after injury it was 6.9 %, after 5 years 32.2 %, after 7 years 36.3 %, and after 10 years 79.6 %. At the same time, the crude relative risk of OA rises as the time interval since injury increases.

The relative risk of OA has already doubled by 2 years after ACL injury). By 7 years it has increased fivefold and compared with OA status at the time of injury it is still increasing significantly after 10 years.

Conclusions

The ACL injury is a significant risk factor for the development of early-onset secondary knee osteoarthritis. Within 5 years of the injury the knee shows clear signs of osteoarthritis on MRI. However, these lesions are often not associated with any clinical signs. Knee osteoarthritis as a severe disease starts 8 years or later after the injury, when it requires treatment.

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Literatur

  1. Ajuied A, Wong F, Smith C et al (2014) Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med 42:2242–2252

    Article  PubMed  Google Scholar 

  2. Altman RD, Hochberg M, Murphy WA Jr et al (1995) Atlas of individual radiographic features in osteoarthritis. Osteoarthritis Cartilage 3(Suppl A):3–70

    PubMed  Google Scholar 

  3. Anderson AF, Irrgang JJ, Kocher MS et al (2006) The International Knee Documentation Committee Subjective Knee Evaluation Form: normative data. Am J Sports Med 34:128–135

    Article  PubMed  Google Scholar 

  4. Aroen A, Loken S, Heir S et al (2004) Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 32:211–215

    Article  PubMed  Google Scholar 

  5. Bjorkman P, Sandelin J, Harilainen A (2015) A randomized prospective controlled study with 5-year follow-up of cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23(8):2353–2359

    Article  PubMed  Google Scholar 

  6. Chalmers PN, Mall NA, Moric M et al (2014) Does ACL reconstruction alter natural history?: a systematic literature review of long-term outcomes. J Bone Joint Surg Am 96:292–300

    Article  PubMed  Google Scholar 

  7. Fairbank TJ (1948) Knee joint changes after meniscectomy. J Bone Joint Surg Br 30B:664–670

    PubMed  CAS  Google Scholar 

  8. Frobell RB, Roos HP, Roos EM et al (2013) Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ 346:f232

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gelber AC, Hochberg MC, Mead LA et al (2000) Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann Intern Med 133:321–328

    Article  PubMed  CAS  Google Scholar 

  10. Hackenbroch MH (2002) Arthrosen. Basiswissen zu Klinik, Diagnostik und Therapie. Thieme, Stuttgart

  11. Higgins JP, Thompson SG, Deeks JJ et al (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560

    Article  PubMed  PubMed Central  Google Scholar 

  12. Hjelle K, Solheim E, Strand T et al (2002) Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 18:730–734

    Article  PubMed  Google Scholar 

  13. Holm I, Oiestad BE, Risberg MA et al (2012) No differences in prevalence of osteoarthritis or function after open versus endoscopic technique for anterior cruciate ligament reconstruction: 12-year follow-up report of a randomized controlled trial. Am J Sports Med 40:2492–2498

    Article  PubMed  Google Scholar 

  14. Jäger M, Wirth CJ (1986) Praxis der Orthopädie. Thieme, Stuttgart

  15. Janssen RP, du Mee AW, van VJ et al (2013) Anterior cruciate ligament reconstruction with 4-strand hamstring autograft and accelerated rehabilitation: a 10-year prospective study on clinical results, knee osteoarthritis and its predictors. Knee Surg Sports Traumatol Arthrosc 21:1977–1988

    Article  PubMed  Google Scholar 

  16. Jonsson H, Riklund-Ahlstrom K, Lind J (2004) Positive pivot shift after ACL reconstruction predicts later osteoarthrosis: 63 patients followed 5–9 years after surgery. Acta Orthop Scand 75:594–599

    Article  PubMed  Google Scholar 

  17. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Kujala UM, Kettunen J, Paananen H et al (1995) Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum 38:539–546

    Article  PubMed  CAS  Google Scholar 

  19. Lebel B, Hulet C, Galaud B et al (2008) Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: a minimum 10-year follow-up. Am J Sports Med 36:1275–1282

    Article  PubMed  Google Scholar 

  20. Leroux T, Ogilvie-Harris D, Dwyer T et al (2014) The risk of knee arthroplasty following cruciate ligament reconstruction: a population-based matched cohort study. J Bone Joint Surg Am 96:2–10

    Article  PubMed  Google Scholar 

  21. Luc B, Gribble PA, Pietrosimone BG (2014) Osteoarthritis prevalence following anterior cruciate ligament reconstruction: a systematic review and numbers-needed-to-treat analysis. J Athl Train 49:806–819

    Article  PubMed  PubMed Central  Google Scholar 

  22. van Meer BL, Meuffels DE, van Eijsden WA et al (2015) Which determinants predict tibiofemoral and patellofemoral osteoarthritis after anterior cruciate ligament injury? A systematic review. Br J Sports Med 49(15):975–983

    Article  PubMed  Google Scholar 

  23. Meuffels DE, Favejee MM, Vissers MM et al (2009) Ten year follow-up study comparing conservative versus operative treatment of anterior cruciate ligament ruptures. A matched-pair analysis of high level athletes. Br J Sports Med 43:347–351

    Article  PubMed  CAS  Google Scholar 

  24. Moksnes H, Engebretsen L, Risberg MA (2013) Prevalence and incidence of new meniscus and cartilage injuries after a nonoperative treatment algorithm for ACL tears in skeletally immature children: a prospective MRI study. Am J Sports Med 41:1771–1779

    Article  PubMed  Google Scholar 

  25. Neuman P, Kostogiannis I, Friden T et al (2009) Patellofemoral osteoarthritis 15 years after anterior cruciate ligament injury – a prospective cohort study. Osteoarthritis Cartilage 17:284–290

    Article  PubMed  CAS  Google Scholar 

  26. Ostenberg A, Roos H (2000) Injury risk factors in female European football. A prospective study of 123 players during one season. Scand J Med Sci Sports 10:279–285

    Article  PubMed  CAS  Google Scholar 

  27. Pinczewski LA, Lyman J, Salmon LJ et al (2007) A 10-year comparison of anterior cruciate ligament reconstructions with hamstring tendon and patellar tendon autograft: a controlled, prospective trial. Am J Sports Med 35:564–574

    Article  PubMed  Google Scholar 

  28. Radin EL, Paul IL, Rose RM (1972) Role of mechanical factors in pathogenesis of primary osteoarthritis. Lancet 1:519–522

    Article  PubMed  CAS  Google Scholar 

  29. Radin EL, Swann DA, Paul IL et al (1982) Factors influencing articular cartilage wear in vitro. Arthritis Rheum 25:974–980

    Article  PubMed  CAS  Google Scholar 

  30. Roe J, Pinczewski LA, Russell VJ et al (2005) A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities. Am J Sports Med 33:1337–1345

    Article  PubMed  Google Scholar 

  31. Rustenbach SJ (2003) Metaanalyse. Eine anwendungsorientierte Einführung. Hans Huber Verlag, Bern

  32. Salmon LJ, Russell VJ, Refshauge K et al (2006) Long-term outcome of endoscopic anterior cruciate ligament reconstruction with patellar tendon autograft: minimum 13-year review. Am J Sports Med 34:721–732

    Article  PubMed  Google Scholar 

  33. Schönberger A, Valentin H, Mehrtens G (2010) Arbeitsunfall und Berufskrankheit. Rechtliche und medizinische Grundlagen für Gutachter, Sozialverwaltung, Berater und Gerichte. Erich Schmidt Verlag, Berlin

  34. Sharma L, Kapoor D (2007) Epidemiology of osteoarthritis. In: Moskowitz RW, Altman R, Hochberg MC, Buckwalter JA, Goldberg VM (Hrsg) Osteoarthritis. Diagnosis, Medical/Surgical Management. Lippincott Williams & Wilkins, Philadelphia S 3–26

    Google Scholar 

  35. Shelbourne KD, Jari S, Gray T (2003) Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J Bone Joint Surg Am 85-A(Suppl 2):8–16

    PubMed  Google Scholar 

  36. Smith TO, Postle K, Penny F et al (2014) Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment. Knee 21:462–470

    Article  PubMed  CAS  Google Scholar 

  37. Song EK, Seon JK, Yim JH et al (2013) Progression of osteoarthritis after double- and single-bundle anterior cruciate ligament reconstruction. Am J Sports Med 41:2340–2346

    Article  PubMed  Google Scholar 

  38. Spahn G, Hofmann GO (2014) [Focal cartilage defects within the medial knee compartment. predictors for osteoarthritis progression]. Z Orthop Unfall 152:480–488

    Article  PubMed  CAS  Google Scholar 

  39. Spahn G, Schiele R, Hofmann GO et al (2011) [The relative risk of knee osteoarthritis after knee injuries – results of a metaanalysis]. Phys Med Rehab Kuror 21:269–279

    Article  Google Scholar 

  40. Spahn G, Felmet G, Hofmann GO (2013) Traumatic and degenerative cartilage lesions: arthroscopic differentiation using near-infrared spectroscopy (NIRS). Arch Orthop Trauma Surg 133:997–1002

    Article  PubMed  Google Scholar 

  41. Struewer J, Ziring E, Frangen TM et al (2013) Clinical outcome and prevalence of osteoarthritis after isolated anterior cruciate ligament reconstruction using hamstring graft: follow-up after two and ten years. Int Orthop 37:271–277

    Article  PubMed  PubMed Central  Google Scholar 

  42. Su F, Hilton JF, Nardo L et al (2013) Cartilage morphology and T1rho and T2 quantification in ACL-reconstructed knees: a 2-year follow-up. Osteoarthritis Cartilage 21:1058–1067

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Sun K, Tian SQ, Zhang JH et al (2009) Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft. Arthroscopy 25:750–759

    Article  PubMed  Google Scholar 

  44. Suomalainen P, Jarvela T, Paakkala A et al (2012) Double-bundle versus single-bundle anterior cruciate ligament reconstruction: a prospective randomized study with 5-year results. Am J Sports Med 40:1511–1518

    Article  PubMed  Google Scholar 

  45. Sward P, Friden T, Boegard T et al (2013) Association between varus alignment and post-traumatic osteoarthritis after anterior cruciate ligament injury. Knee Surg Sports Traumatol Arthrosc 21:2040–2047

    Article  PubMed  Google Scholar 

  46. Sward P, Kostogiannis I, Neuman P et al (2010) Differences in the radiological characteristics between post-traumatic and non-traumatic knee osteoarthritis. Scand J Med Sci Sports 20:731–739

    Article  PubMed  CAS  Google Scholar 

  47. Tan SH, Lau BP, Khin LW et al (2015) The importance of patient sex in the outcomes of anterior cruciate ligament reconstructions: a systematic review and meta-analysis. Am J Sports Med. [Epub ahead of print]

  48. Tourville TW, Johnson RJ, Slauterbeck JR et al (2013) Assessment of early tibiofemoral joint space width changes after anterior cruciate ligament injury and reconstruction: a matched case-control study. Am J Sports Med 41:769–778

    Article  PubMed  Google Scholar 

  49. Tveit M, Rosengren BE, Nilsson JA et al (2012) Former male elite athletes have a higher prevalence of osteoarthritis and arthroplasty in the hip and knee than expected. Am J Sports Med 40:527–533

    Article  PubMed  Google Scholar 

  50. Widuchowski W, Widuchowska M, Koczy B et al (2012) Femoral press-fit fixation in ACL reconstruction using bone-patellar tendon-bone autograft: results at 15 years follow-up. BMC Musculoskelet Disord 13:115

    Article  PubMed  PubMed Central  Google Scholar 

  51. Zagrodnik FD, Bolm-Audorff U, Eberth F et al (2012) Außerberufliche Faktoren der Gonarthrose. Trauma Berufskrankh 14(Suppl 4):399–401

    Article  Google Scholar 

  52. Ziegler A, Konig IR (2011) [Guidelines for research reports: German translation of CONSORT 2010, PRISMA and STARD]. Dtsch Med Wochenschr 136:357–358

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Praxisklinik für Unfallchirurgie und Orthopädie Eisenach und Universitätsklinium Jena, Sophienstraße 16, 99817, Eisenach, Deutschland

    G. Spahn

  2. Ambulanz und Tagesklinik für Schmerztherapie, Gutachtenambulanz, Klinik für Orthopädie und Unfallchirurgie, Department Orthopädie, Unfallchirurgie und Paraplegiologie, Universitätsklinikum Heidelberg, Schlierbacher Landstraße 200 a, 69118, Heidelberg, Deutschland

    M. Schiltenwolf

  3. Steinbeker Grenzdamm 30 d, 22115, Hamburg, Deutschland

    B. Hartmann

  4. Asklepios Klinikum Bad Abbach GmbH, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland

    J. Grifka

  5. Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Berufsgenossenschaftlichen Klinik Bergmannstrost Halle/Saale, Universitätsklinikum Jena, Erlanger Allee 101, 07747, Jena, Deutschland

    G.O. Hofmann

  6. Freies Institut für medizinische Begutachtungen Bayreuth/Erlangen, Ludwigstraße 25, 95444, Bayreuth, Deutschland

    H.-T. Klemm

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Correspondence to G. Spahn.

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G. Spahn, M. Schiltenwolf, B. Hartmann, J. Grifka, G.O. Hofmann und H.-T. Klemm geben an, dass kein Interessenkonflikt besteht.

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Spahn, G., Schiltenwolf, M., Hartmann, B. et al. Das zeitabhängige Arthroserisiko nach vorderer Kreuzbandverletzung. Orthopäde 45, 81–90 (2016). https://doi.org/10.1007/s00132-015-3170-4

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