Knee osteoarthritis risk is increased 4-6 fold after knee injury – a systematic review and meta-analysis
Top Cited Papers
- 9 May 2019
- journal article
- review article
- Published by BMJ in British Journal of Sports Medicine
- Vol. 53 (23), 1454-1463
- https://doi.org/10.1136/bjsports-2018-100022
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 CRD42015016900Keywords
This publication has 70 references indexed in Scilit:
- Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysisKnee Surgery, Sports Traumatology, Arthroscopy, 2012
- The association between radiographic knee osteoarthritis and knee symptoms, function and quality of life 10-15 years after anterior cruciate ligament reconstructionBritish Journal of Sports Medicine, 2010
- Meniscal tear in knees without surgery and the development of radiographic osteoarthritis among middle‐aged and elderly persons: The multicenter osteoarthritis studyArthritis & Rheumatism, 2009
- The occurrence of osteoarthritis at a minimum of ten years after reconstruction of the anterior cruciate ligamentJournal of Orthopaedic Surgery and Research, 2008
- High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injuryArthritis & Rheumatism, 2004
- Measuring inconsistency in meta-analysesBMJ, 2003
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- The Effect of Partial Meniscectomy on the Long-Term Prognosis of Knees with Localized, Severe Chondral DamageThe American Journal of Sports Medicine, 1996
- Development of criteria for the classification and reporting of osteoarthritis: Classification of osteoarthritis of the kneeArthritis & Rheumatism, 1986
- Results After Meniscectomy in 147 AthletesActa Orthopaedica, 1980