Risk factors of OA after ACL injuries

Anterior cruciate ligament (ACL) rupture is a common sports-related injury, with an annual incidence of approximately 5/10 000 persons in the general population.^[1] Osteoarthritis (OA) is a well-known, long-term complication of ACL rupture, with a prevalence of 10–90% at 10–20 years postinjury.^[2,3] It is important to identify the risk factors contributing to OA in patients with ACL rupture, because some risk factors may be modifiable as to prevent onset or early-stage progression of OA.

To identify those ACL injured patients at increased risk for knee OA, it is necessary to understand risk factors for OA.

Aim To summarise the evidence for determinants of (1) tibiofemoral OA and (2) patellofemoral OA in ACL injured patients.

Methods MEDLINE, EMBASE, Web of Science and CINAHL databases were searched up to 20 December 2013. Additionally, reference lists of eligible studies were manually and independently screened by two reviewers. 2348 studies were assessed for the following main inclusion criteria: ≥20 patients; ACL injured patients treated operatively or non-operatively; reporting OA as outcome; description of relationship between OA outcome and determinants; and a follow-up period ≥2 years. Two reviewers extracted the data, assessed the risk of bias and performed a best-evidence synthesis.

Results Sixty-four publications were included and assessed for quality. Two studies were classified as low risk of bias. Medial meniscal injury/meniscectomy showed moderate evidence for influencing OA development (tibiofemoral OA and compartment unspecified). Lateral meniscal injury/meniscectomy showed moderate evidence for no relationship (compartment unspecified), as did time between injury and reconstruction (tibiofemoral and patellofemoral OA).

Conclusions Medial meniscal injury/meniscectomy after ACL rupture increased the risk of OA development. In contrast, it seems that lateral meniscal injury/meniscectomy has no relationship with OA development. Our results suggest that time between injury and reconstruction does not influence patellofemoral and tibiofemoral OA development. Many determinants showed conflicting and limited evidence and no determinant showed strong evidence.

Read more:

Belle L van Meer; Duncan E Meuffels; Wilbert A van Eijsden; Jan A N Verhaar; Sita M A Bierma-Zeinstra; Max Reijman: Which Determinants Predict Tibiofemoral and Patellofemoral Osteoarthritis After Anterior Cruciate Ligament Injury? -A Systematic Review. Br J Sports Med. 2015;49(15):975-983