Imaging Modalities Show Promise in Diagnosing Posttraumatic Osteoarthritis in Athletes After ACL Injury
Posttraumatic osteoarthritis (PTOA) remains a significant long-term complication following knee injuries such as anterior cruciate ligament (ACL) ruptures and meniscal tears, particularly in athletic populations. A recent narrative review published in PM&R, assessed the effectiveness of imaging modalities to guide diagnosis and management of PTOA in athletes under 50 years of age, aiming to improve long-term outcomes through earlier and more accurate detection.
“ACL injury may lead to a 3-fold increase in osteoarthritis compared to the contralateral knee, within 12–14 years after surgery,” the study authors noted. Meniscus injuries further increase the risk, with PTOA prevalence reported as high as 100% in some patients with combined injuries.
The review included 23 studies, categorized by imaging type: 8 used x-ray (XR), 13 employed magnetic resonance imaging (MRI), and 2 used ultrasound (US). Studies were required to involve active individuals with Tegner Activity Scale scores between 4 and 9 and had to document cartilage loss and/or PTOA of the knee. Importantly, patients with rheumatologic conditions or prior joint surgeries were excluded.
The included imaging studies varied in their ability to reliably identify early disease. While x-rays remain a standard modality, MRI was more frequently utilized in studies, likely reflecting its superior ability to visualize soft tissue and cartilage. “Use of valid, reliable, and disease-specific objective clinical outcome measures may guide the diagnosis and treatment of PTOA in athletes and physically active individuals,” the authors emphasized.
This review underscores the multifactorial pathophysiology of PTOA, which involves not only mechanical injury but also biochemical pathways including proinflammatory mediators released shortly after trauma. The unique needs of athletic populations—who often return to high-impact activity—make timely and accurate diagnosis particularly critical.
“Identifying reliable markers of disease represents an important first step,” the study concluded, with the broader goal of optimizing nonsurgical strategies for managing PTOA in younger, active patients. Clinicians should consider integrating more advanced imaging tools, particularly MRI, into post-injury surveillance protocols to better monitor joint health in at-risk populations.
Reference
Fogarty AE, Chiang MC, Douglas S, et al. Posttraumatic osteoarthritis after athletic knee injury: A narrative review of diagnostic imaging strategies. PM R. 2025;17(1):96-106. doi:10.1002/pmrj.13217
