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Performance after ACL reconstruction and risk of osteoarthritis

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Summary of an article on the relationship between functional performance one year after ACL reconstruction and the risk of early osteoarthritis.


78 participants (30 females, 48 males) with MRI assessments available 1 and 5 years after ACL reconstruction surgery aged 28 (±15) years.


Prospective cohort study.

Outcome measures/tests

  • functional performance: single leg hop, triple-crossover hop, side-hop (40cm, 30 seconds), and one-leg-rise
  • if symmetry between legs was <90% on the test, the performance was considered poor
  • osteoarthritis (patellofemoral, tibiofemoral) progression (3T MRI)

Main results

  • The prevalence of radiographic osteoarthritis increased from 6% at 1 year to 19% at 5 years.
  • Only 20% of participants had at least 90% symmetry on all performance tests 1 year after ACL reconstruction.
  • Of those who had a poor function at 1 year (9 people), 33% had radiographic osteoarthritis at 5 years.
  • Poor functional performance (all tests <90%) was associated with a 3.66 times greater risk of worsening patellofemoral bone marrow lesions.
  • One repetition less on side-hop test is associated with an 8% increase in the risk of worsening of patellofemoral bone marrow lesion.
  • There was no association between performance at 1 year and the worsening of tibiofemoral osteoarthritis at 5 years.

Take home message

For a clinician & coach
Poor hopping performance (<90% symmetry on a battery of tests) at 1 year was associated with worsening of patellofemoral bone marrow lesion.
For a parent
Poor symmetry between legs on hopping tests was associated with worsening of osteoarthritis of the knee.
For an athlete
If you had an ACL injury and subsequent surgery, aim at symmetric (the same on both legs) performance on hopping on one-leg rise at 1 year after your surgery.

Original article

Patterson B, Culvenor AG, Barton CJ, Guermazi A, Stefanik J, Morris HG, Whitehead TS, Crossley KM. Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression. British Journal of Sports Medicine. 2020 May 1;54(9):546-53.

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