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 Compared to people without knee injuries, individuals with injuries
to the anterior cruciate ligament (ACL) were more than four times as
likely to develop knee osteoarthritis, the study found. People with
injuries to the meniscus cartilage alone or in combination with an
ACL injury were more than six times as prone to osteoarthritis,
researchers note in the British Journal of Sports Medicine.
The estimates are drawn from analyses of 53 previously published
studies with more than 1 million participants, including about
185,000 with these knee injuries.
"The injury itself damages the tissue and complete recovery of the
knee is rarely gained," said lead study author Erik Poulsen of the
University of Southern Denmark in Odense.
"Cartilage and ligaments have much poorer healing capabilities due
to limited blood supply," Poulsen said by email. "This change in
structure changes the biomechanics of the joint and can lead to
osteoarthritis. Further, the often-substantial trauma not only tears
the ligament or the meniscus but also causes damage to the cartilage
and bone."
The results suggest that meniscal injuries in isolation or in
combination with ACL damage may be an even more important risk
factor for osteoarthritis than an ACL injury alone, the study
authors conclude. Many patients had surgery for ACL injuries, and
this also didn't appear to be as big a risk factor as a meniscal
injury.
Eleven studies involving roughly 185,000 people investigated ACL
injuries. Patients in these studies were 28 years old on average at
the time of injury.
Another 22 studies focused on meniscal injuries. These studies
included about 83,000 people with an average age of about 38 at the
time of injury.
In 25 studies examining combined ACL and meniscal injuries, patients
were 31 years old, on average, at the time of injury.
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Most studies followed patients for at least a decade, and the risk
of osteoarthritis associated with knee injuries appeared to increase
over time.
A leading cause of pain and disability in older adults, knee
osteoarthritis occurs when flexible tissue at the ends of bones
wears down. While it can't be cured, physical therapy or
anti-inflammatory medications are often prescribed to relieve pain
and improve mobility.
One limitation of the analysis is that some of the studies lacked
data on whether patients had osteoarthritis before their knee
injuries, the study authors note.
However, several factors can increase the risk of osteoarthritis
after a knee injury, including muscle weakness, altered
biomechanics, poor functional capacity like decreased ability to hop
or jump, and being overweight or obese, said Adam Culvenor, a sports
medicine researcher at La Trobe University in Melbourne, Australia.
"Returning to sport after injury doesn't seem to be associated with
increased risk of osteoarthritis longer term, so we can educate our
patients about the importance of optimizing muscle strength and
function and maintaining a healthy weight and physical activity,"
Culvenor, who wasn't involved in the study, said by email. "But It
is important to note that, to date, no data exists from high
quality, randomized controlled trials to show that post-traumatic
osteoarthritis can be prevented."
SOURCE: https://bit.ly/2QyQdkx British Journal of Sports Medicine,
online May 9, 2019.
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