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69 Systematic review and meta-analysis of randomised controlled trials and cohort studies of risk factors for knee osteoarthritis after trauma (OPTIKNEE)
  1. Jackie L Whittaker1,
  2. Justin Losciale1,
  3. Carsten Juhl3,
  4. Jonas Thorlund3,
  5. Matilde Lundberg3,
  6. Linda Truong1,
  7. Maxi Miciak4,
  8. Belle van Meer5,
  9. Adam Culvenor6,
  10. Kay Crossley6,
  11. Ewa Roos3,
  12. L Stefan Lohmander7,
  13. Marienke van Middelkoop5
  1. 1University of British Columbia, Department of Physical Therapy, 2177 Wesbrook Mall, Canada
  2. 2Arthritis Research Canada, 2238 Yukon Street, Canada
  3. 3University of Southern Denmark, Denmark
  4. 4University of Alberta, Faculty of Rehabilitation, Canada
  5. 5Erasmus MC Medical University Center, Netherlands
  6. 6La Trobe University, Australia
  7. 7Lund University, Sweden


Introduction It is unclear why some people develop osteoarthritis after knee trauma and others don’t. This study identified risk factors for osteoarthritis following knee trauma.

Materials and Methods After protocol registration, 5 databases were searched to 09–2021. RCTs and cohort studies assessing risk factors for symptomatic or structural osteoarthritis in persons with knee trauma, mean injury age ≤30-years, and minimum 2-year follow-up were included. Record screening, data extraction and risk-of-bias assessment was duplicated (blinded). Meta-analyses (random effects models) estimated the odds of osteoarthritis for risk factors assessed in ≥4 studies. Remaining risk factors underwent semi-quantitative synthesis. The GRADE approach for prognostic factors guided assessment.

Results Across 66 included studies, 81 unique risk factors were identified. 64% and 49% of studies had high risk-of-bias from attrition and confounding. Semi-quantitative syntheses identified limited high-quality evidence that cruciate ligament, collateral ligament, meniscal, chondral, dislocation, fracture, and multi-structure injuries increase symptomatic osteoarthritis odds. Ten risk factors for structural osteoarthritis underwent meta-analysis (sex, rehabilitation for ACL tear, ACL reconstruction (ACLR), ACLR age, ACLR body-mass-index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low quality evidence suggests increased odds of structural osteoarthritis related to ACLR+cartilage injury (OR=2.31; 95%CI 1.35,3.94), ACLR+partial meniscectomy (OR=1.87; 1.45,2.42), and ACLR+total medial meniscectomy (OR=3.14; 2.20,4.48).

Conclusion Limited high-quality evidence suggests that various knee injury types (not just ACL tears) increase symptomatic osteoarthritis. Risk factor heterogeneity, low-quality evidence, and inconsistency in risk factor and osteoarthritis definition make identifying modifiable targets for preventing symptomatic post-traumatic knee osteoarthritis challenging.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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