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Ebrahim Piri1 
, AmirAli Jafarnezhadgero *1 , Mahrokh Dehghani1 , Farhad Rezazadeh1 , Afsaneh Enteshari-Moghaddam2
, AmirAli Jafarnezhadgero *1 , Mahrokh Dehghani1 , Farhad Rezazadeh1 , Afsaneh Enteshari-Moghaddam2
1- Department of Sports Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
2- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
2- Department of Internal Medicine, Faculty of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract: (23 Views)
Background: While ACL injury and surgery are significant causes of post-traumatic knee osteoarthritis, the specific factors leading to arthritis in the tibiofemoral joint versus the patellofemoral joint are not well understood. This research sought to pinpoint compartment-specific risks for arthritis progression after ACL reconstruction.
Methods: A comprehensive bibliographic search was performed utilizing six databases: PubMed, Scopus, EMBASE, the Cochrane Library, Medline, and Google Scholar. The search strategy was guided by the PICOS framework and incorporated both MeSH and relevant free-text keywords. Complete search syntax for each database is provided, including Boolean operators (AND, OR), language restrictions English, and filters for study design. The search was limited to publications from the decade spanning 2015 to 2025, thereby capturing evidence that reflects contemporary clinical methodologies in surgery, rehabilitation, and diagnostic imaging. This 10-year timeframe captures recent high-quality cohort studies and meta-analyses while allowing adequate follow-up for long-term osteoarthritis outcomes to develop after ACLR. Studies were used if they applied risk factors or predictors for TFJ or PFJ osteoarthritis following ACLR.
Findings: The final meta-analysis synthesized data from nine eligible studies (970 participants). The results showed a positive association between medial meniscectomy and the development of TFJOA, evidenced by a substantial effect size (SMD = 1.57, 95% CI [1.28, 1.87], p < 0.001) and considerable heterogeneity (I² = 75%). Similarly, residual knee laxity quantified as a side-to-side alteration > 3 mm on instrumented testing demonstrated a strong and consistent relationship with TFJOA (SMD = 1.82, 95% CI [1.67, 1.97], p< 0.001, I² = 0%). Conversely, the risk profile for PFJOA was predominantly linked to neuromuscular and biomechanical deficits. Significant predictors for PFJOA included patellar malalignment (SMD = 1.53, 95% CI [1.27, 1.79], p < 0.001, I² = 0%) and persistent quadriceps weakness (SMD = 1.34, 95% CI [1.14, 1.54], p < 0.001, I² = 15%). A lower peak knee flexion moment during running was also identified as a significant risk factor (SMD = 1.58, 95% CI [1.38, 1.79], p < 0.001, I² = 0%). In contrast, the choice of graft type (hamstring tendon Vs. bone-patellar tendon-bone) did not demonstrate a significant influence on either TFJOA or PFJOA risk factors.
Conclusion: This review establishes that TFJ and PFJ OA follow distinct pathomechanical pathways post-ACLR, challenging the traditional uniform approach to post-ACLR management. Our findings support the implementation of compartment-specific rehabilitation strategies: addressing mechanical instability (e.g., meniscectomy, laxity) for TFJ OA and neuromuscular dysfunction (e.g., quadriceps weakness, malalignment) for PFJ OA. This tailored approach is essential to mitigate long-term OA development and should guide follow-up care.
Methods: A comprehensive bibliographic search was performed utilizing six databases: PubMed, Scopus, EMBASE, the Cochrane Library, Medline, and Google Scholar. The search strategy was guided by the PICOS framework and incorporated both MeSH and relevant free-text keywords. Complete search syntax for each database is provided, including Boolean operators (AND, OR), language restrictions English, and filters for study design. The search was limited to publications from the decade spanning 2015 to 2025, thereby capturing evidence that reflects contemporary clinical methodologies in surgery, rehabilitation, and diagnostic imaging. This 10-year timeframe captures recent high-quality cohort studies and meta-analyses while allowing adequate follow-up for long-term osteoarthritis outcomes to develop after ACLR. Studies were used if they applied risk factors or predictors for TFJ or PFJ osteoarthritis following ACLR.
Findings: The final meta-analysis synthesized data from nine eligible studies (970 participants). The results showed a positive association between medial meniscectomy and the development of TFJOA, evidenced by a substantial effect size (SMD = 1.57, 95% CI [1.28, 1.87], p < 0.001) and considerable heterogeneity (I² = 75%). Similarly, residual knee laxity quantified as a side-to-side alteration > 3 mm on instrumented testing demonstrated a strong and consistent relationship with TFJOA (SMD = 1.82, 95% CI [1.67, 1.97], p< 0.001, I² = 0%). Conversely, the risk profile for PFJOA was predominantly linked to neuromuscular and biomechanical deficits. Significant predictors for PFJOA included patellar malalignment (SMD = 1.53, 95% CI [1.27, 1.79], p < 0.001, I² = 0%) and persistent quadriceps weakness (SMD = 1.34, 95% CI [1.14, 1.54], p < 0.001, I² = 15%). A lower peak knee flexion moment during running was also identified as a significant risk factor (SMD = 1.58, 95% CI [1.38, 1.79], p < 0.001, I² = 0%). In contrast, the choice of graft type (hamstring tendon Vs. bone-patellar tendon-bone) did not demonstrate a significant influence on either TFJOA or PFJOA risk factors.
Conclusion: This review establishes that TFJ and PFJ OA follow distinct pathomechanical pathways post-ACLR, challenging the traditional uniform approach to post-ACLR management. Our findings support the implementation of compartment-specific rehabilitation strategies: addressing mechanical instability (e.g., meniscectomy, laxity) for TFJ OA and neuromuscular dysfunction (e.g., quadriceps weakness, malalignment) for PFJ OA. This tailored approach is essential to mitigate long-term OA development and should guide follow-up care.
Type of Study: Systematic Review |
Subject:
Sports biomechanics
Received: 2025/08/10 | Accepted: 2025/10/18
Received: 2025/08/10 | Accepted: 2025/10/18
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