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Poor functional performance 1 year after ACL reconstruction increases the risk of early osteoarthritis progression
  1. Brooke Patterson1,
  2. Adam Geoffrey Culvenor1,2,
  3. Christian J Barton1,
  4. Ali Guermazi3,
  5. Joshua Stefanik4,
  6. Hayden G Morris5,
  7. Timothy S Whitehead6,
  8. Kay M Crossley1
  1. 1Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
  2. 2Institute of Anatomy, Paracelsus Medical University, Salzburg & Nuremberg, Salzburg, Austria
  3. 3Department of Radiology, School of Medicine, Boston University, Boston, Massachusetts, USA
  4. 4Department of Physical Therapy, Movement and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA
  5. 5The Park Clinic, St Vincent's Private Hospital, Melbourne, Victoria, Australia
  6. 6Orthosport Victoria, Epworth HealthCare, Richmond, Victoria, Australia
  1. Correspondence to Professor Kay M Crossley, Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3086, Australia; k.crossley{at}


Background Not meeting functional performance criteria increases reinjury risk after ACL reconstruction (ACLR), but the implications for osteoarthritis are not well known.

Objective To determine if poor functional performance post-ACLR is associated with risk of worsening early osteoarthritis features, knee symptoms, function and quality of life (QoL).

Methods Seventy-eight participants (48 men) aged 28±15 years completed a functional performance test battery (three hop tests, one-leg-rise) 1 year post-ACLR. Poor functional performance was defined as <90% limb symmetry index (LSI) on each test. At 1 and 5 years, MRI, Knee injury Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective form were completed. Primary outcomes were: (i) worsening patellofemoral and tibiofemoral MRI-osteoarthritis features (cartilage, bone marrow lesions (BMLs) and meniscus) and (ii) change in KOOS and IKDC scores, between 1 and 5 years.

Results Only 14 (18%) passed (≥90% LSI on all tests) the functional test battery. Poor functional performance on the battery (all four tests <90% LSI) 1 year post-ACLR was associated with 3.66 times (95% CI 1.12 to 12.01) greater risk of worsening patellofemoral BMLs. A triple-crossover hop <90% LSI was associated with 2.09 (95% CI 1.15 to 3.81) times greater risk of worsening patellofemoral cartilage. There was generally no association between functional performance and tibiofemoral MRI-osteoarthritis features, or KOOS/IKDC scores.

Conclusion Only one in five participants met common functional performance criteria (≥90% LSI all four tests) 1 year post-ACLR. Poor function on all four tests was associated with a 3.66 times increased risk of worsening patellofemoral BMLs, and generally not associated with decline in self-reported outcomes.

  • anterior cruciate ligament reconstruction
  • osteoarthritis
  • magnetic resonance imaging
  • patient reported outcomes
  • rehabilitation

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  • Contributors BP, AG and KAC conceived and designed the study. HGM and TSW assisted with recruitment of participants. BP, JS and AGC conducted the statistical analysis and interpretation of data, with input from CB and KMC. BP drafted the manuscript with input from AG, CJB, KAC, JS, HGM, TSW and KAC. All authors have read and approved the final manuscript.

  • Funding Support for this study was provided by Arthritis Australia, La Trobe University Sport, Exercise and Rehabilitation Research Focus Area, the Queensland Orthopaedic Physiotherapy Network, the University of Melbourne (Research Collaboration grant) and the University of British Columbia Centre for Hip Health and Mobility (Society for Mobility and Health). BP was the recipient of the Felice Rosemary-Lloyd Travel Scholarship, which assisted with travel and data analysis to visit coauthor JS at the University of Delaware. BP, AC and CB are recipients of National Health and Medical Research Council awards (post-graduate scholarship No. 1114296, Neil Hamilton Fairley Clinical Fellowship No. 1121173 and MRFF Translating Research into Practice No. 11163250, respectively). JS is supported by a NIH/NIGMS grant U54-GM104941.

  • Competing interests AG received consulting fees for grading of MRI images at baseline and follow-up. He is a shareholder of Boston Imaging Core Lab (BICL) and a consultant to Merck Serono, Pfizer, GE Healthcare, Galapagos, Roche and TissueGene.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by the La Trobe University Human Ethics Committee (HEC15-100) and all participants signed informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Reuse will be permitted by the corresponding author, and can occur up until 2027, which corresponds with the conditions of the La Trobe University Human Ethics committee that indicates data will be kept for at least 10 years following completion of data collection.