Protective Role of Muscle Function for Early Features of Knee Osteoarthritis After Anterior Cruciate Ligament Injury

Completed

• Conditions: Osteoarthritis, Knee; Muscle Weakness; Anterior Cruciate Ligament Injury; Knee Osteoarthritis
• Interventions: Other: Measures of muscle function

• Registration Number: NCT03473873
• Lead Sponsor: Lund University

Brief Summary

In this longitudinal prospective cohort study including young people with anterior cruciate ligament reconstruction (ACLR), the aims are to 1) study the association between different measures of muscle function and early future of knee osteoarthritis (OA) assessed as patient-reported pain, 2) explore potential associations between muscle function and features indicative of early radiographic OA measured with MRI, and early detection of OA in biomarker profiles, respectively, 3) monitor the patients' functional status, and early OA development over time and 4) investigate the prevalence of early knee OA in individuals 1 and 3 years post ACLR, respectively, compared to non-injured controls.The main hypothesis is that knee extensor weakness predicts future symptomatic OA of the knee (KOOS pain).

Detailed Description

This is a longitudinal, prospective, cohort study. The reporting will adhere to the STROBE guidelines. Approximately 100 patients 12 months (range 10 - 16 months) after anterior cruciate ligament reconstruction (ACLR) will be recruited from Skåne University Hospital, Sweden and Ullevål Hospital, Oslo, Norway. The majority of the patients (approx. 80 %) will be recruited in Sweden. As a sample of convenience, 20 age- and sex-matched non-knee injured individuals will be recruited among students in Lund, Sweden.

A research coordinator at each site will determine eligibility for the study, based on pre-specified inclusion and exclusion criteria. Patients will be provided with written and oral information about the study. Patients who accept to participate will be assessed with various measures of muscle function, patient-reported outcomes, MRI, and blood samples for biomarker analyses, at baseline (1 year after ACLR) and 2 years later (3 years after ACLR).

For descriptive purposes, the mean difference (95% CI), or median (quartiles), between baseline and follow-up assessments will be used as appropriate. Separate linear regression model will be used to elucidate the influence of change in each muscle function variable on change in primary, secondary and exploratory outcomes (biomarkers), adjusted for baseline values. Separate linear regression models will also be used to elucidate the influence of demographic factors on change in muscle function, self-reported outcomes, and early OA. Assuming a clinically relevant correlation of 0.30 between knee extension strength and self-reported pain, 84 patients are needed with 80% power at the 5% significance level. Based on this calculation, 100 patients will be included, including an approximate drop-out of 15%. For explorative purposes, an analysis of covariance (ANCOVA) will be used to investigate differences in the presence of early knee OA between the 100 patients with ACLR and twenty sex and age matched non-injured individuals, adjusting for activity level.

Study Timeline

• Study Start: 2018-03-09
• Study First Submitted: 2018-03-09
• Study First Submitted QC: 2018-03-21
• Study First Posted: 2018-03-22
• Primary Completion: 2023-07-01
• Study Completion: 2023-07-01
• Status Verified: 2023-10
• Last Update Submitted: 2023-10-03
• Last Update Posted: 2023-10-04

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 106

Inclusion Criteria

Not provided

Exclusion Criteria

• Less than 10 months after ACLR
• More than 16 months after ACLR
• Injury or surgery to other knee (e.g., ACL, meniscal)
• Previous knee surgery index knee
• Previous serious knee injury index knee resulting in pain, swelling, and/or requiring inpatient or outpatient health care (e.g., ACLR, meniscus, patella luxation)
• Diseases or disorders overriding the knee condition (e.g., neurological disease)
• Contraindications for MRI
• Not understanding the languages of interest (any Scandinavian language or English)

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
SHIELD	Measures of muscle function	Patients with anterior cruciate ligament injury

Primary Outcome Measures

Name	Time	Method
Patient-reported pain	Change from baseline to 2-year follow up	Knee Osteoarthritis Outcome Score (KOOS) subscale pain

Secondary Outcome Measures

Name	Time	Method
Compositional MRI (T2 relaxation time and 3DPD)	Change from baseline to 2-year follow up	Compositional MRI, a proxy for early morphological degeneration of joint structures. Quantitative morphology of cartilage quality will be made using T2 mapping, to measure collagen orientation changes within the cartilage, and bone shape (3DPD)

Trial Locations

Locations (2)

Eva Ageberg; 🇸🇪 Lund, Sweden

May Arna Risberg; 🇳🇴 Oslo, Norway