{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:07:07Z","timestamp":1788883627217,"version":"build-2803163510"},"reference-count":25,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T00:00:00Z","timestamp":1704758400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006075","name":"Greta och Johan Kocks stiftelser","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006075","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>It is unclear how anterior cruciate ligament (ACL) reconstruction (ACLR) affects the development of osteoarthritis (OA). This uncertainty is partly caused by the lack of long-term studies on ACL injuries treated primarily without reconstruction and the underreporting of symptomatic OA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To determine (1) the knee function, symptoms, and activity level, as well as the presence of radiographic and symptomatic OA; (2) how these clinical outcomes have changed over time; and (3) the frequency of subsequent knee surgeries after the index ACL injury in a cohort of patients with ACL injuries treated primarily without reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Case series; Level of evidence, 4.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A total of 100 patients underwent initial nonoperative treatment &gt;30 years ago (mean, 33.2 \u00b1 1.4 years). Of these, 81 patients (mean age, 59 \u00b1 8 years) completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale, and Tegner Activity Scale. Seventy-three patients underwent radiography to evaluate tibiofemoral and patellofemoral OA in the ACL-injured knee. Patients only underwent late ACLR if they experienced insufficient knee stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At 33 years after the ACL injury, the KOOS Activities of Daily Living subscore was better than population-based reference values, but scores were similar for the remaining KOOS subscales. Furthermore, 65% of patients had a good or excellent Lysholm score (\u226584 points). The Tegner score decreased 4 points from before the injury to 33-year follow-up ( P &lt; .001). Most patients (75%) had evidence of radiographic tibiofemoral and\/or patellofemoral OA, but only 38% were classified as having symptomatic OA (defined as radiographic OA in combination with a symptomatic knee according to cutoffs on the KOOS). Approximately 50% underwent meniscal surgery, and 29% subsequently underwent ACLR for recurrent instability. There were 2 patients who underwent total knee replacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Despite a high prevalence of radiographic OA, patients achieved acceptable subjective knee function and had a relatively low prevalence of symptomatic OA at &gt;30 years after an ACL injury when an initial nonoperative treatment strategy was employed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465231214423","type":"journal-article","created":{"date-parts":[[2024,1,9]],"date-time":"2024-01-09T04:00:24Z","timestamp":1704772824000},"page":"320-329","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Outcomes &gt;30 Years After Initial Nonoperative Treatment of Anterior Cruciate Ligament Injuries"],"prefix":"10.1177","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9593-1048","authenticated-orcid":false,"given":"Clara","family":"Hellberg","sequence":"first","affiliation":[{"name":"Clinical Epidemiology Unit, Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Kostogiannis","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandros","family":"Stylianides","sequence":"additional","affiliation":[{"name":"Musculoskeletal Radiology Section, Sk\u00e5ne University Hospital, Lund University, Lund, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Neuman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Clinical Sciences Malm\u00f6, Lund University, Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,1,9]]},"reference":[{"key":"bibr1-03635465231214423","first-page":"3","volume":"3","author":"Altman RD","year":"1995","journal-title":"Osteoarthritis Cartilage"},{"key":"bibr2-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-9-116"},{"key":"bibr3-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2016.03.010"},{"key":"bibr4-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1002\/art.11088"},{"key":"bibr5-03635465231214423","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2022.973870"},{"key":"bibr6-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-018-5296-5"},{"key":"bibr7-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1007\/s00402-022-04662-4"},{"key":"bibr8-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1136\/ard.16.4.494"},{"key":"bibr9-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507299238"},{"key":"bibr10-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1177\/0363546520939897"},{"key":"bibr11-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2019-100765"},{"key":"bibr12-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1177\/0363546507307396"},{"key":"bibr13-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1016\/j.knee.2008.11.004"},{"key":"bibr14-03635465231214423","doi-asserted-by":"publisher","DOI":"10.4085\/1062-6050-49.3.35"},{"key":"bibr15-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2005.03.010"},{"key":"bibr16-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1177\/0363546508316770"},{"key":"bibr17-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509338827"},{"key":"bibr18-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-7-38"},{"key":"bibr19-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1007\/s00167-022-06960-1"},{"key":"bibr20-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-1-64"},{"key":"bibr21-03635465231214423","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1136\/bjsports-2019-100959","volume":"54","author":"Snoeker BA","year":"2020","journal-title":"Br J Sports Med"},{"key":"bibr22-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-198509000-00007"},{"key":"bibr23-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1177\/0363546517751683"},{"key":"bibr24-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-020-02156-5"},{"key":"bibr25-03635465231214423","doi-asserted-by":"publisher","DOI":"10.1177\/0363546515621554"}],"container-title":["The American Journal of Sports Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465231214423","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/03635465231214423","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/03635465231214423","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T09:50:10Z","timestamp":1777369810000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/03635465231214423"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,9]]},"references-count":25,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,2]]}},"alternative-id":["10.1177\/03635465231214423"],"URL":"https:\/\/doi.org\/10.1177\/03635465231214423","relation":{},"ISSN":["0363-5465","1552-3365"],"issn-type":[{"value":"0363-5465","type":"print"},{"value":"1552-3365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,9]]}}}