February 16, 2007

Investigators track ACL injuries’ impact on arthritis

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Kurt Spindler, M.D., is studying the relationship between certain knee surgeries and arthritis. (photo by Dana Johnson)

Investigators track ACL injuries’ impact on arthritis

This illustration shows the location of the anterior cruciate ligament (ACL) and how it can be injured. (illustration by Medical Art Group)

This illustration shows the location of the anterior cruciate ligament (ACL) and how it can be injured. (illustration by Medical Art Group)

Vanderbilt's Kurt Spindler, M.D., and orthopaedic colleagues across the country are taking a hard look at what it is about anterior cruciate ligament (ACL) injuries that plays a role in the development of degenerative arthritis.

Caused by the breakdown and loss of cartilage in the joints, degenerative arthritis, or osteoarthritis, afflicts an estimated 20 million people in the United States.

Vanderbilt University Medical Center, along with six other academic institutions across the country, is investigating the long-term effects that ACL reconstruction surgery has on the development of degenerative arthritis. The study is being funded by a four-year, $1.2 million grant from the National Institutes of Health.

Vanderbilt is the coordinating site for the multi-center cohort study entitled “Prognosis and Predictors of ACL Reconstruction: a Multicenter Cohort Study.” Enrollment is expected to reach 3,000.

Patients who undergo ACL reconstructive surgery can have several outcomes — return to active status, re-injury or the development of post-surgical arthritis.

“We are hoping to determine the most important predictors that lead to future arthritis in the knees of ACL reconstructive patients,” said Spindler, director of the Division of Sports Medicine and head physician for Vanderbilt Athletics.

“What stops young people or athletes from playing sports is the development of arthritis in their knees. We can fix ligament instabilities and remove loose bodies in the knee, but when they wear away the articular surface, which leads to the development of arthritis, we have no cure for that.

“Our ultimate goal is to develop an equation to determine at the time of surgery what a person's risk profile is to developing arthritis,” Spindler said.

“Perhaps we can counsel them to avoid things that will lead to arthritis and investigate how we can prevent arthritis from developing in the knees.”

Patients in the study will undergo extensive evaluation including diagnostic and functional testing to look at what factors affect the likelihood of developing arthritis.

There are various dynamics to study, including the actual injury, type of treatment, surgery, patient's weight and possibly socioeconomic status.

“There is a myriad of things that can influence these factors,” said Spindler. “This is more than just dealing with young active people and returning them to their former lives. The things we learn can potentially help all people who might be at risk developing arthritis in their knees.”

The other sites involved in the study include, the Cleveland Clinic, Ohio State University, Hospital for Special Surgery in New York, Washington University in St. Louis, Iowa University and the University of Colorado.

Spindler attributes the grant award to the collaboration with the Health Services Research Center headed by Robert Dittus, M.D., and the Department of Biostatistics, led by Frank Harrell, Ph.D. Both areas are “critical members of Vanderbilt's central coordinating center,” Spindler said.