{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:17:44Z","timestamp":1792444664969,"version":"4.5.0"},"reference-count":58,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T00:00:00Z","timestamp":1627776000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Journal of Sports Medicine"],"published-print":{"date-parts":[[2021,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (&lt;6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (&gt;6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Cohort study; Level of evidence, 2.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&amp;L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&amp;L grade \u22652 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain \u226472. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&amp;L grade \u22652\/osteophyte (definite osteophyte without joint space narrowing) and K&amp;L grade \u22651.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&amp;L grade \u22652) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&amp;L grade \u22652\/osteophyte and K&amp;L grade \u22651, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259671211027530","type":"journal-article","created":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T10:39:43Z","timestamp":1629196783000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study"],"prefix":"10.1177","volume":"9","author":[{"given":"Marie","family":"Pedersen","sequence":"first","affiliation":[{"name":"Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hege","family":"Grindem","sequence":"additional","affiliation":[{"name":"Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway."},{"name":"Stockholm Sports Trauma Research Center, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rnar","family":"Berg","sequence":"additional","affiliation":[{"name":"Orthopedic Clinic, Oslo University Hospital, Oslo, Norway."},{"name":"Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragnhild","family":"Gunderson","sequence":"additional","affiliation":[{"name":"Department of Radiology, Oslo University Hospital, Oslo, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Engebretsen","sequence":"additional","affiliation":[{"name":"Oslo Sport Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway."},{"name":"Orthopedic Clinic, Oslo University Hospital, Oslo, Norway."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Axe","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Delaware, Newark, Delaware, USA."},{"name":"First State Orthopaedics, Newark, Delaware, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Snyder-Mackler","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, University of Delaware, Newark, Delaware, USA."},{"name":"Graduate Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"May Arna","family":"Risberg","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway."},{"name":"Orthopedic Clinic, Oslo University Hospital, Oslo, 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