Knee osteoarthritis risk is increased 4-6 fold after knee injury: a systematic review and meta-analysis

Erik Poulsen* (Corresponding Author), Glaucia H. Goncalves, Alessio Bricca, Ewa M. Roos, Jonas B. Thorlund, Carsten B. Juhl

*Corresponding author for this work

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

OBJECTIVE: To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls.

STUDY APPRAISAL AND SYNTHESIS: Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis.

RESULTS: 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively.

CONCLUSION: The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates.

CLINICAL RELEVANCE: Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.PROSPERO registration number CRD42015016900.

Original languageEnglish
Pages (from-to)1454-1463
Number of pages10
JournalBritish Journal of Sports Medicine
Volume53
Issue number23
Early online date14 Nov 2019
DOIs
Publication statusPublished - Dec 2019

Fingerprint

Knee Injuries
Knee Osteoarthritis
Meta-Analysis
Wounds and Injuries
Knee
Anterior Cruciate Ligament
Secondary Prevention
Checklist
MEDLINE
Retrospective Studies
Anterior Cruciate Ligament Injuries
Prospective Studies

Keywords

  • anterior cruciate ligament
  • knee injuries
  • meniscus
  • meta-analysis
  • osteoarthritis

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Orthopedics and Sports Medicine

Cite this

Knee osteoarthritis risk is increased 4-6 fold after knee injury : a systematic review and meta-analysis. / Poulsen, Erik (Corresponding Author); Goncalves, Glaucia H.; Bricca, Alessio; Roos, Ewa M.; Thorlund, Jonas B.; Juhl, Carsten B.

In: British Journal of Sports Medicine, Vol. 53, No. 23, 12.2019, p. 1454-1463.

Research output: Contribution to journalReview article

Poulsen, Erik ; Goncalves, Glaucia H. ; Bricca, Alessio ; Roos, Ewa M. ; Thorlund, Jonas B. ; Juhl, Carsten B. / Knee osteoarthritis risk is increased 4-6 fold after knee injury : a systematic review and meta-analysis. In: British Journal of Sports Medicine. 2019 ; Vol. 53, No. 23. pp. 1454-1463.
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abstract = "OBJECTIVE: To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury.DESIGN: Systematic review and meta-analysis.DATA SOURCES: MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018.ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls.STUDY APPRAISAL AND SYNTHESIS: Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis.RESULTS: 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35{\%} females, 98{\%} surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36{\%} females, 22{\%} confirmed meniscectomy and 73{\%} unknown; 725 362 participants with combined injury, mean age 31 years, 26{\%} females, 80{\%} treated surgically. The OR of developing knee OA were 4.2 (95{\%} CI 2.2 to 8.0; I2=92{\%}), 6.3 (95{\%} CI 3.8 to 10.5; I2=95{\%}) and 6.4 (95{\%} CI 4.9 to 8.3; I2=62{\%}) for patients with ACL injury, meniscal injury and combined injuries, respectively.CONCLUSION: The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates.CLINICAL RELEVANCE: Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.PROSPERO registration number CRD42015016900.",
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T1 - Knee osteoarthritis risk is increased 4-6 fold after knee injury

T2 - a systematic review and meta-analysis

AU - Poulsen, Erik

AU - Goncalves, Glaucia H.

AU - Bricca, Alessio

AU - Roos, Ewa M.

AU - Thorlund, Jonas B.

AU - Juhl, Carsten B.

PY - 2019/12

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N2 - OBJECTIVE: To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury.DESIGN: Systematic review and meta-analysis.DATA SOURCES: MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018.ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls.STUDY APPRAISAL AND SYNTHESIS: Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis.RESULTS: 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively.CONCLUSION: The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates.CLINICAL RELEVANCE: Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.PROSPERO registration number CRD42015016900.

AB - OBJECTIVE: To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury.DESIGN: Systematic review and meta-analysis.DATA SOURCES: MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018.ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls.STUDY APPRAISAL AND SYNTHESIS: Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis.RESULTS: 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively.CONCLUSION: The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates.CLINICAL RELEVANCE: Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.PROSPERO registration number CRD42015016900.

KW - anterior cruciate ligament

KW - knee injuries

KW - meniscus

KW - meta-analysis

KW - osteoarthritis

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