Risk of post‐traumatic knee osteoarthritis after knee injury in military service members

Abstract

Purpose: The aims of the present study were: (a) to identify the incidence of osteoarthritis (OA) after a traumatic knee injury; (b) identify the risk of post-traumatic osteoarthritis (PTOA) based on the type of injury; and (c) identify the time from injury to OA diagnosis.Patients and methods: The Expeditionary Medical Encounter Database, containing healthcare utilization for all deployment injuries sustained by military service members, was queried for traumatic knee injuries between 2001 and 2016. Subsequent diagnosis of knee OA was identified, defined as PTOA. Time to knee PTOA diagnosis was determined and logistic regression was used to obtain odds ratios (ORs) (95% confidence interval [CI]) between knee injury type and development of PTOA.Results: A total of 345 (9.57%) of the 3,605 subjects were diagnosed with PTOA.The median time to diagnosis was 4.10 years. Four primary diagnoses remained significantly associated with PTOA after adjusting for age and injury severity score: fracture (adjusted OR [aOR] = 1.36; 95% CI 1.02, 1.82), sprain (aOR = 1.59; 95% CI 1.23, 2.06), dislocation (aOR = 3.70; 95% CI 2.09, 6.55) and derangement (aOR = 2.38; 95% CI 1.33, 4.28). Subjects were significantly less likely to develop PTOA after a softtissue injury (aOR = 0.44; 95% CI 0.41, 0.75). Conclusions:A substantial number of individuals with a traumatic knee injury developed early PTOA (9.6%). Certain knee injuries have a greater association with PTOA. Future studies should implement longer surveillance periods and identify other healthcare variables associated with the risk of developing PTOA, to include appropriate and timely interventions.

Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta-analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus

“…Included studies are summarised in the online supplemental file. Twenty-four were RCTs,35–58 17 were prospective cohort studies29 59–74 and 25 were retrospective cohort studies 28 75–98. Fifty-eight (89%) of the studies assessed participants with an ACL tear (with and without concomitant injuries),29 35–44 46–71 73–89 91 92 94 98 three (5%) considered multiple knee injuries,72 93 97 two (4%) meniscal injuries only,28 90 one (2%) cartilage injuries only45 and one (2%) patellar dislocations only 96.…”

“…Twenty-four were RCTs,35–58 17 were prospective cohort studies29 59–74 and 25 were retrospective cohort studies 28 75–98. Fifty-eight (89%) of the studies assessed participants with an ACL tear (with and without concomitant injuries),29 35–44 46–71 73–89 91 92 94 98 three (5%) considered multiple knee injuries,72 93 97 two (4%) meniscal injuries only,28 90 one (2%) cartilage injuries only45 and one (2%) patellar dislocations only 96. Only eight (12%) of the studies assessed risk factors for symptomatic OA (four ICD-9 or 10 diagnostic codes for OA, two physician chart, one symptomatic radiographic, one KOOS (Knee Injury and Osteoarthritis Outcome Score)) 37 80 88 90 93 95–97.…”

“…Fifty-eight (89%) of the studies assessed participants with an ACL tear (with and without concomitant injuries),29 35–44 46–71 73–89 91 92 94 98 three (5%) considered multiple knee injuries,72 93 97 two (4%) meniscal injuries only,28 90 one (2%) cartilage injuries only45 and one (2%) patellar dislocations only 96. Only eight (12%) of the studies assessed risk factors for symptomatic OA (four ICD-9 or 10 diagnostic codes for OA, two physician chart, one symptomatic radiographic, one KOOS (Knee Injury and Osteoarthritis Outcome Score)) 37 80 88 90 93 95–97. In contrast, 50 (76%) assessed risk factors for structural OA alone (49 radiographs, 1 MRI),28 29 35 36 38–60 62–64 68–73 75 76 78 79 81–84 86 87 91 92 94 98 and 8 (12%) assessed risk factors for both (eight symptomatic radiographic) 61 65–67 74 77 85 89.…”

“…Across included studies, 81 unique potential risk factors were identified including 46 for symptomatic OA and 62 for structural OA, spanning 10 broad categories (figures 2 and 3). Categories included demographics (n=19)38 54 59 60 66 67 69 74–76 78 80 81 83 84 89 94–96; follow-up time (n=5)38 54 75 84 89; injury type (n=22)29 41 51 59 64–68 70–72 76 81 84 88 89 93 95–98; treatment approach (n=14)44 50 61 64 71 72 74 80 83 85 87 88 95 98; surgery type (n=30)28 29 38 40 44 45 50 51 53 59 61 64 69 71 72 74–76 78 80 81 83–85 87 88 90 95 96 98; ACL reconstruction (ACLR) surgical technique (n=9)37 40–43 47 48 50 55; ACLR graft choice (n=20)35 36 38 39 46 49 51–53 56–58 62 66 81 86 91 92 94 95; post-ACL injury or ACLR status (n=17)29 38 59 62 66 69 71 73 74 76–82 89 91 94; joint morphology (n=2)75 96; and biomarkers (n=1) 63. Twenty-seven (59%) of the 46 potential risk factors for symptomatic OA and 39 (63%) of the 62 potential risk factors for structural OA were assessed in only one study.…”

Reduced miR‑519d‑3p levels in the synovium and synovial fluid facilitate the progression of post‑traumatic osteoarthritis by targeting VEGF

“…At present, the early diagnosis of PTOA is diffi� cult (5). Due to a lack of specific interventions, PTOA seriously affects the daily life of patients (6). Therefore, investigation into potential biomarkers of PTOA will aid in improving joint function and the quality of life of patients with PTOA.…”