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Degenerative changes after posterior cruciate ligament reconstruction are irrespective of posterior knee stability: MRI-based long-term results

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Posterior cruciate ligament reconstruction (PCLR) is advocated to prevent an early onset of osteoarthritis. We hypothesized that posterior instability after PCLR correlates with degenerative changes.

Materials and methods

MRIs of 42 (12 female/30 male; 39 ± 9 years) patients were enrolled with a minimum 5-year follow-up (FFU) after PCLR. In addition, 25 contralateral and 15 follow-up MRIs (12 months after baseline) were performed. Degenerative changes were graded using WORMS. Posterior tibial translation (PTT) was measured using posterior stress radiographs. Outcome parameters included WORMS/cartilage subscore for the whole joint, patellofemoral (PFJ), medial (MFTJ), and lateral femorotibial joint (LFTJ).

Results

Final follow-up was 101 (range 68–168) months. WORMS reached 41.5 [18.5–56.8]. Regional WORMS for PFJ was significantly higher than MFTJ and LFTJ. Cartilage subscore yielded 7 [2.8–15]. MFTJ and PFJ were significantly higher than LFTJ. Primary outcome parameters were significantly higher than the contralateral knee (P < 0.0001) and significantly increased within 12 months (P = 0.0002). There was a significant correlation between the intraoperative degree of cartilage injury and WORMS (P < 0.0001 with r = 0.64) and between the number of previous surgery and the cartilage subscore (P = 0.03 with r = 0.32). Meniscal surgery led to a significantly higher WORMS (P = 0.035). Combined risk models revealed that women below the mean age had significantly lower WORMS (P = 0.001) and cartilage subscores (P = 0.003).

Conclusions

Patients undergo degenerative changes after PCLR, which are significantly higher compared to the contralateral knee. These occur predominantly at PFJ/MFTJ and are irrespective of posterior stability. Concomitant meniscus/cartilage injuries and a high number of previous surgeries are further risk factors.

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Acknowledgements

We thank the Institute for Radiology and Nuclear Medicine of the Charité-University, especially Imke Schatka MD and Gerd Diederichs MD, PhD Medicine Berlin for their continuous support and image allocation.

Author information

Authors and Affiliations

  1. Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Clemens Gwinner & Tobias M. Jung

  2. Sporthopaedicum, Berlin, Germany

    Andreas Weiler

  3. Center for Radiology and Nuclear Medicine, Charité-University Medicine Berlin, Berlin, Germany

    Timm Denecke & Julian M. M. Rogasch

  4. Julius Wolff Institute, Charité-University Medicine Berlin, Berlin, Germany

    Heide Boeth

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  1. Clemens Gwinner
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All authors have seen and approved submission of the manuscript, and have taken due care to ensure the integrity of the work. According to the “Uniform requirements for manuscripts submitted to biomedical journals”, all authors have contributed significantly to the study.

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Correspondence to Clemens Gwinner.

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All authors declare that they have not received any funding or research grants in the course of study, research, or assembly of the manuscript.

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Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. More specifically, none of the authors received payments or services, either directly or indirectly (i.e., via his or her institution) from a third party in support of any aspect of this work. None of the authors, or their institution(s), had any financial relationship, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. In addition, all authors declare that they have had no other relationships, or have been engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work.

Ethical review

The study was performed at Charité-Universitaetsmedizin Berlin, Germany and carried out in accordance with the Tenets of the Declaration of Helsinki. The study protocol was approved by the institutional ethics commission (Approval number: EA2/067/17) of Charité-Universitaetsmedizin Berlin, Germany.

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Gwinner, C., Weiler, A., Denecke, T. et al. Degenerative changes after posterior cruciate ligament reconstruction are irrespective of posterior knee stability: MRI-based long-term results. Arch Orthop Trauma Surg 138, 377–385 (2018). https://doi.org/10.1007/s00402-017-2855-z

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