Torn ACL: still no answers on 10-year rate of knee osteoarthritis

  • Lie MM & al.
  • Br J Sports Med
  • 01/04/2019

  • Miriam Davis, PhD
  • Clinical Essentials
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Takeaway

  • This systematic review of studies published after 2008 finds insufficient data on the rate of knee osteoarthritis (KOA) 10 years after tear of the anterior cruciate ligament (ACL).
  • This is the same conclusion reached by the same authors in an earlier review published in 2009.
  • Meniscectomy (needed for meniscus injury, which occurs in 21%-48% with ACL injury) is the only consistent risk factor for KOA.

Why this matters

  • Results are frustrating for a common injury whose annual incidence in the general population is 68.6 per 100,000 person-years.

Study design

  • Systematic review of 41 new studies (n=4919) from 5 databases: PubMed, EMBASE, AMED, CINAHL, and SPORTDiscus.
  • Funding: None.

Key results

  • Age of patients at inclusion ranged from 23 to 38 years; follow-up from 31 to 51 years.
  • 96% of patients had surgery.
  • Few studies differentiated between radiographic vs symptomatic KOA.
  • Radiographic KOA:
    • Prevalence ranges between 0% and 100% more than 10 years after injury, irrespective of follow-up time of the study.
  • Symptomatic KOA:
    • 1 study reported a rate of 35% in the tibiofemoral joint.
    • 1 study reported a rate of 15% in the patellofemoral joint.
  • Meniscectomy represented the only consistent risk factor predicting KOA.

Limitations

  • Low methodological quality in more than half of 41 studies.