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The objectives of this study are to review the long-term consequences of injuries to the anterior cruciate ligament and menisci, the pathogenic mechanisms, and the causes of the considerable variability in outcome. Injuries of the anterior cruciate ligament and menisci are common in both athletes and the general population. At 10 to 20 years after the diagnosis, on average, 50% of those with a diagnosed anterior cruciate ligament or meniscus tear have osteoarthritis with associated pain and functional impairment: the young patient with an old knee. These individuals make up a substantial proportion of the overall osteoarthritis population. There is a lack of evidence to support a protective role of repair or reconstructive surgery of the anterior cruciate ligament or meniscus against osteoarthritis development. A consistent finding in a review of the literature is the often poor reporting of critical study variables, precluding data pooling or a meta-analysis. Osteoarthritis development in the injured joints is caused by intra-articular pathogenic processes initiated at the time of injury, combined with long-term changes in dynamic joint loading. Variation in outcome is reinforced by additional variables associated with the individual such as age, sex, genetics, obesity, muscle strength, activity, and reinjury. A better understanding of these variables may improve future prevention and treatment strategies. In evaluating medical treatment, we now expect large randomized clinical trials complemented by postmarketing monitoring. We should strive toward a comparable level of quality of evidence in surgical treatment of knee injuries. In instances in which a randomized clinical trial is not feasible, natural history and other observational cohort studies need to be as carefully designed and reported as the classic randomized clinical trial, to yield useful information.

/pdf/the-long-term-consequence-of-anterior-cruciate-ligament-and-3mhkqdkmu4.pdf

The Long-term Consequence of Anterior Cruciate Ligament and Meniscus Injuries Osteoarthritis

https://www.oarsijournal.com/article/S1063-4584(02)90801-0/pdf

Articular cartilage repair: basic science and clinical progress. A review of the current status and prospects.

Most common human traits and diseases have a polygenic pattern of inheritance: DNA sequence variants at many genetic loci influence the phenotype. Genome-wide association (GWA) studies have identified more than 600 variants associated with human traits, but these typically explain small fractions of phenotypic variation, raising questions about the use of further studies. Here, using 183,727 individuals, we show that hundreds of genetic variants, in at least 180 loci, influence adult height, a highly heritable and classic polygenic trait. The large number of loci reveals patterns with important implications for genetic studies of common human diseases and traits. First, the 180 loci are not random, but instead are enriched for genes that are connected in biological pathways (P = 0.016) and that underlie skeletal growth defects (P < 0.001). Second, the likely causal gene is often located near the most strongly associated variant: in 13 of 21 loci containing a known skeletal growth gene, that gene was closest to the associated variant. Third, at least 19 loci have multiple independently associated variants, suggesting that allelic heterogeneity is a frequent feature of polygenic traits, that comprehensive explorations of already-discovered loci should discover additional variants and that an appreciable fraction of associated loci may have been identified. Fourth, associated variants are enriched for likely functional effects on genes, being over-represented among variants that alter amino-acid structure of proteins and expression levels of nearby genes. Our data explain approximately 10% of the phenotypic variation in height, and we estimate that unidentified common variants of similar effect sizes would increase this figure to approximately 16% of phenotypic variation (approximately 20% of heritable variation). Although additional approaches are needed to dissect the genetic architecture of polygenic human traits fully, our findings indicate that GWA studies can identify large numbers of loci that implicate biologically relevant genes and pathways.

Hundreds of variants clustered in genomic loci and biological pathways affect human height

The Knee injury and Osteoarthritis Outcome Score (KOOS) was developed as an extension of the WOMAC Osteoarthritis Index with the purpose of evaluating short-term and long-term symptoms and function in subjects with knee injury and osteoarthritis. The KOOS holds five separately scored subscales: Pain, other Symptoms, Function in daily living (ADL), Function in Sport and Recreation (Sport/Rec), and knee-related Quality of Life (QOL). The KOOS has been validated for several orthopaedic interventions such as anterior cruciate ligament reconstruction, meniscectomy and total knee replacement. In addition the instrument has been used to evaluate physical therapy, nutritional supplementation and glucosamine supplementation. The effect size is generally largest for the subscale QOL followed by the subscale Pain. The KOOS is a valid, reliable and responsive self-administered instrument that can be used for short-term and long-term follow-up of several types of knee injury including osteoarthritis. The measure is relatively new and further use of the instrument will add knowledge and suggest areas that need to be further explored and improved.

/pdf/the-knee-injury-and-osteoarthritis-outcome-score-koos-from-2dx5z6eued.pdf

The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis.

To the Editor: We previously published results of our randomized trial of treatment for anterior cruciate ligament tears (July 22, 2010, issue).1 In Table 3 of that article, which shows primary, secondary, and exploratory outcomes at 2 years, the P values and confidence intervals were calculated in compliance with the “Points to Consider on Adjustment for Baseline Covariates,” in the European Medicines Agency guidelines a distinction that was not stated in the article. Accordingly, the P values were adjusted for baseline value, whereas the unadjusted confidence intervals were calculated by maximum-likelihood estimation. There were no significant between-group differences in either . . .

More on Treatment for Acute Anterior Cruciate Ligament Tears

Levy and colleagues misinterpreted our report on the five year outcome of treatment for rupture of the anterior cruciate ligament (ACL).1 2

We assessed whether structured rehabilitation plus early ACL reconstructive surgery was superior to structured rehabilitation with optional delayed reconstruction.3 We found no significant differences in primary or secondary outcomes between the two treatment strategies at …

https://www.bmj.com/content/bmj/346/bmj.f2082.full.pdf

Authors' response to editorial by Levy and colleagues on Treating ACL injuries in young moderately active adults.

A systematic review and meta-analysis of arthroscopic surgery for degenerative tears of the meniscus was recently published on cmaj.ca.[1][1] We commend the authors for their timely work summarizing the available scientific evidence.

The authors evaluated “the efficacy of arthroscopic meniscal d

/pdf/a-more-correct-interpretation-pjpuklsv39.pdf

A more correct interpretation.

Sir,—The paper by Laaksonen et al. (2020) in this issue of Acta Orthopaedica shows practice variation and possible overtreatment for a common orthopedic presentation: completely displaced (includin...

https://www.tandfonline.com/doi/pdf/10.1080/17453674.2020.1854505

Is there a reason to challenge our current practice in children's forearm fractures?

We appreciate the interest that Reginster and colleagues1 showed in our publication on subgroup effects of oral glucosamine for osteoarthritis (OA).2 We are pleased that the eLetter authors do not put forward any critique of our publication that requires our justification or clarification.

As highlighted by the authors,1 the effectiveness of oral glucosamine products for knee and hip OA symptoms has been questioned. Nevertheless, due to the heterogeneous nature of the disease, whether certain subgroups of patients with OA could benefit from glucosamine has not been excluded. Since available randomised controlled trials are usually not …

https://ard.bmj.com/content/annrheumdis/77/7/e40.full.pdf

L. Stefan Lohmander

Papers

More on Treatment for Acute Anterior Cruciate Ligament Tears

Authors' response to editorial by Levy and colleagues on Treating ACL injuries in young moderately active adults.

A more correct interpretation.

Is there a reason to challenge our current practice in children's forearm fractures?

Response to: 'Different glucosamine sulfate products generate different outcomes on osteoarthritis symptoms' by Reginster et al.