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AOSSM 2022 Annual Meeting Recordings - no CME
Symptoms of post-traumatic osteoarthritis remain s ...
Symptoms of post-traumatic osteoarthritis remain stable up to 10 years after ACL reconstruction
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Video Transcription
Thanks, Chris. Yeah, I'm happy to report Morgan's doing well, but he did get COVID and asked me to step in for him. So this is some data from the MOON study. There's been a lot of information given at this meeting about the infrastructure, et cetera, so I won't spend a lot of time on that, but it is a multicenter cohort, and these are the participating sites, contributing patients. So we know that ACL reconstruction can restore stability and get athletes back to play and higher levels of activity, but they're still at risk of pain from post-traumatic arthritis, and that's something we all want to better understand. So the purpose of this was to determine the incidence of clinically significant symptoms of OA knee pain at 2, 6, and 10-year follow-up. After ACL reconstruction. So like I said, it's a multicenter cohort study, over 3,000 patients enrolled. Patients at time zero complete their PRO instruments, which include the COOS, IKDC, and activity level. Surgeons complete a very thorough documentation of intra-articular findings and some details about reconstruction, et cetera. And then the patients are followed up at 2, 6, and 10 years, and those same patient-reported outcome instruments are administered. So for definition of this study, the patients were sort of three different thresholds were examined to define symptomatic or asymptomatic knees at each time point, 2, 6, and 10 years. One threshold was choosing the worst case scenario of a COOS pain less than or equal to 70. This number is approximately what you would see in preoperative, the higher end of what you would see in preoperative patients undergoing total knee arthroplasty. Then a level down from that was choosing a COOS pain threshold of less than or equal to 80. And then another threshold was just did they even answer a question as moderate, severe, or extreme to any of the COOS pain questions. And this has been used in some trials for OA, so we tested this threshold as well. And we hypothesized that over time, the incidence of knee pain would increase after ACL reconstruction. So the median age in the cohort was 23, is almost half female. Follow up at two years was 85%, six years, 84, and at 10, 77, and still over 2,000, well over 2,000 patients in each of those groups that comprise this sample. So here's the results. Choosing these three different thresholds, COOS pain less than or equal to 70. At two years, a little over 9%. At six years, roughly 9%. At 10 years, roughly 9%. Using the next threshold of COOS pain less than or equal to 80, of course it goes up, because this is a lesser threshold. 16.5%, and then at 10 years, 15.7. Those were not statistically different from one another. And I would submit to you that they're probably not clinically significant. Now, just answering any question about moderate, severe, extreme, at two years it was 26.3%, and then at six, 22.9, and then at 10, 22.6. This was tested and is statistically significant, but again, I don't know if this is clinically meaningful to us. So it does not look as though the symptoms of knee pain increase, at least for a decade post ACL reconstruction. At least not on any of those three thresholds that we chose to examine. So post-traumatic arthritis, symptoms from it look to be stable up to a decade after ACL reconstruction. We're all interested in preventing post-traumatic arthritis, and it looks like we should focus on that early period after the time of injury, since it looks to me, I would posit that it's in that window, that it's going to put you into one of those categories. And then once you're there, it appears to be stable, at least up for a decade. And the formal definition of post-traumatic arthritis includes symptoms, but also imaging. And so certainly, this could be an area for future study. Thank you.
Video Summary
In this video, the speaker discusses the findings of the MOON study on knee pain after ACL reconstruction. The purpose of the study was to determine the incidence of knee pain at 2, 6, and 10-year follow-up after ACL reconstruction. The study included over 3,000 patients, and patient-reported outcome instruments were used to assess knee symptoms. The results indicated that the incidence of knee pain did not increase significantly over time, and there was no significant difference when using different pain thresholds. The speaker suggests that focusing on preventing post-traumatic arthritis in the early period after injury may be important. Further research on symptoms and imaging is suggested. No credits were mentioned.
Asset Caption
Morgan Jones, MD
Keywords
MOON study
knee pain
ACL reconstruction
patient-reported outcome instruments
post-traumatic arthritis
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