TY - JOUR
T1 - Knee osteoarthritis risk is increased 4-6 fold after knee injury - 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
N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/12
Y1 - 2019/12
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 Injuries/complications
KW - Humans
KW - Knee Injuries/complications
KW - Osteoarthritis, Knee/etiology
KW - Risk Factors
KW - Tibial Meniscus Injuries/complications
U2 - 10.1136/bjsports-2018-100022
DO - 10.1136/bjsports-2018-100022
M3 - Review
C2 - 31072840
SN - 0306-3674
VL - 53
SP - 1454
EP - 1463
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
IS - 23
ER -