Using Ultrasound after an ACL Reconstruction

March 16, 2019

A patient after an anterior cruciate ligament reconstruction (ACLR) faces higher risk of osteoarthritis, and that's especially concerning to athletic trainers and sports medicine professionals because research suggests that athletes are more prone to osteoarthritis than the general population.

“It has to do with putting a lot of miles on the body. It can be very frustrating for athletes who are used to being exceptional at what they do and using their strength, mind, body and spirit to excel at their sport,” says Dr. Jason Genin, a physician at the Cleveland Clinic specializing in orthopedics and sports medicine who works with the Cleveland Indians and Cleveland Cavaliers, in an article on U.S. News and World Report.

Osteoarthritis is a degenerative condition and there is currently no way to slow its progression.  The one thing sports medicine professionals can do is study athletes who have undergone ACLR and determine if they are are prone to develop osteoarthritis after the ALCR occurs.

An article on the Sports Medicine Research website states that "Diagnostic ultrasound is a clinically accessible method for sports medicine professionals to achieve this goal by observing changes in structures like articular cartilage."

This article reports on a study analyzing diagnostic ultrasound to compare anterior femoral cartilage thickness between knees of people with a history of ACLR and between knees with an ACLR or healthy controls. The researchers studied 20 people with unilateral ACLR that were greater than 6 months post-surgery vs. 28 healthy individuals with similar demographics and population.  They specifically addressed cartilage thickness at the medial, lateral, and intercondylar areas.

"ACLR participants had thicker medial condyle cartilage and greater cartilage cross-sectional area in their ACLR knee compared to their uninjured knee and compared to healthy individuals," the article states. "The researchers used a limb symmetry index (involved/uninvolved x 100) to provide a quantitative comparison of cartilage measurements between limbs within the ACLR participants. Using this measure, the researchers found that patients with more cartilage surface area in the involved knee seemed to be further away from their ACLR surgery date."

The articles states that, "Interestingly, cartilage thickening is thought to be a very early stage of OA despite the cause being unknown.  Thickening may be related to cartilage swelling, which weakens the tissue."

The article concludes, "This study is a nice demonstration that ultrasound may serve as a potential tool for clinicians to identify and monitor cartilage changes in patients during their rehabilitation and return to physical activity so that they can most safely return with limited long-term complications."

In addition to thnking about options such as Ultraosund treatment to detect potential issues with osteoarthritis for your athletes who undergo ACLR, the U.S. News and World Report article points out the importance of always evaluating the prospect of osteoarthritis with your athletes who experience symptoms.  The article lists the following reasons why it's important to stay on top of this :

  • Symptoms of osteoarthritis can become more prouned if not addressed. “We’re not sure if it causes more degeneration, but if you continue to put heavy loads on the joints, it has the potential to make osteoarthritis pain worse,” Genin said in the article.
  • If you evaluate an arthlete for osteoarthritis based on symptoms, you may find a related muscle or tendon injury.
  • Without having more clarity, the athlete or their parents may stress about whether there's potential for osteoarthritis.

In terms of treatment for osteoarthritis, Genin says in the article that there are a number of approaches, but that the method of treatment needs to be customized to the individual. “Some athletes need anti-inflammatories and physical therapy. Others need an exercise plan and injections,” he says. “It depends on the person and the stage of arthritis."

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