One in Three Patients Experience Persistent Early Osteoarthritis Symptoms Two Years After ACL Reconstruction
A study using data from the New Zealand ACL Registry has found that nearly one-third of patients who undergo anterior cruciate ligament reconstruction (ACLR) report persistent symptoms suggestive of early osteoarthritis (OA) within 2 years of surgery.
The findings were published in Arthritis Care & Research.
The analysis included 10,231 patients aged 14 to 40 years who completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 6, 12, and 24 months post-ACLR. Symptoms were defined as suggestive of early OA when patients scored ≤85% on at least 2 of 4 KOOS subscales.
At 6 months post-ACLR, 68% of patients met the criteria for symptoms suggestive of early OA. This declined to 54% at 12 months and 46% at 24 months. However, 33% of patients had persistent symptoms across all 3 timepoints. Only 23% reported no symptoms during follow-up, while 29% showed resolution, 6% developed new symptoms, and 9% had inconsistent symptoms.
“These findings indicate that symptoms are more likely to persist rather than newly develop,” the authors wrote. “One third of patients experience persistent symptoms, suggesting a substantial burden of early OA following ACLR.”
Women were significantly more likely to report symptoms, with odds ratios ranging from 1.17 to 1.52. Older patients also had higher odds of symptoms, especially at 6 months post-surgery, with odds ratios ranging from 1.64 to 2.45.
The authors emphasized the clinical relevance of early symptom tracking. “These findings underscore the importance of early identification and targeted interventions,” they concluded.
For rheumatologists and sports medicine specialists, the study highlights a need for close monitoring of post-ACLR patients, especially women and older individuals, and supports integrating OA risk assessments into rehabilitation protocols to help mitigate long-term joint degeneration.
Reference
Harkey MS, Driban JB, Todem D, et al. Evaluating criteria for symptoms suggestive of early osteoarthritis over two years post-anterior cruciate ligament reconstruction: data from the new zealand anterior cruciate ligament registry. Arthritis Care Res (Hoboken). 2025;77(4):475-483. doi:10.1002/acr.25453
