Which determinants predict patellofemoral osteoarthritis after anterior cruciate ligament reconstruction? A narrative literature review
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AbstractWhich determinants predict patellofemoral osteoarthritis after anterior cruciate ligament reconstruction? A narrative literature review

Anterior cruciate ligament reconstruction (ACLR) is one of the options for treatment to ACL rupture. In recent years, more conservative treatment is chosen than before, because many papers reported that ACLR is one of the risk factors inducing tibiofemoral joint (TFJ) and patellofemoral joint (PFJ) osteoarthritis (OA).
The previous paper presented a common question: which determinants influence the development of degenerative changes on PFJ after ACLR? This literature review will only focus on PFJ OA in populations that have accepted ACLR and explore what risk factors that have not been evaluated after ACLR will be likely to induce PFJ OA.

Key words were searched in databases including Pubmed, Embase, WoS and MEDLINE (OVID). The key words are listed as follows:
1. anterior cruciate*[tw] OR acl[tw];
2. reconstruct*[tw];
3. patell*[tw] OR patellofemoral [tw];
4. (osteoarthrit*[tw] OR osteo-arthrit*[tw] OR osteoarthro*[tw] OR osteo-arthro [tw] OR arthrosis[tw] OR arthroses[tw] OR arthrot*[tw] OR gonarthro*[tw] OR degen*[tw])
Other relevant publications from reference list were also included.

Finally, 21 studies were included in this review. The prevalence of PFJ OA after ACLR reported in the literature is 11%~81% (Figure 1). Most of the studies evaluating the relationship between OA in the knee joint and ACLR focused on TFJ rather than PFJ (the ratio is approximately 4:1). TFJ dominates the knee joint and it is understandable that TFJ has a great effect on PFJ.
Specifically, most studies indicated that after ACLR a larger range of motion in tibial exteral rotation is exhibited, which leads to increased patellar tilt and PFJ load.1 More external rotation also results in increased length of patella tendon and alterations of orientation between patella tendon and tibia long axis. All of these contributors are likely to lead to lateral tilt and external rotation of patella, which predispose to PFJ OA initiation or progression. (Figure 2)

Contact pressure and area were measured by pressure sensors (Figure 3) which were placed on between femur and patella after ACLR. It was exhibited that after meniscectomy, the range of femoral rotation increases and has mechanical effects on PFJ, thus leading to alteration of PFJ contact pressure and area, which is likely to induce PFJ OA.

1. Deneweth et al., AJSM 38(9):1820-8.
2. Netravali, Journal of biomechanics. 2010 16(15):2948-53.
All Author(s) ListHUANG W.H., MOK K.M., CHAN Y.C., FUNG P.W., FU S.C., YUNG P.S.H., CHAN K.M.
Name of Conference8th WACBE World Congress on Bioengineering 2017
Start Date of Conference30/07/2017
End Date of Conference02/08/2017
Place of ConferenceHong Kong, China
Country/Region of ConferenceHong Kong
LanguagesEnglish-United States
Keywordsanterior cruciate ligament reconstruction, biomechanics, patellofemoral joint

Last updated on 2018-20-01 at 18:58