1. In this systematic review and meta-analysis, moderate certainty evidence suggested that damage to various structures of the knee may increase the odds of symptomatic osteoarthritis (OA).
2. Furthermore, modifiable risk factors for OA remain more established than modifiable risk factors for post-traumatic OA.
Evidence Rating Level: 1 (Excellent)
OA is the most common joint condition affects millions of people worldwide. Post-traumatic OA represents at least 12% of these cases. Unlike the availability of high-level evidence to guide prevention of post-traumatic knee OA, there is a gap that remains in how to delay or prevent the development of OA after a traumatic injury. As a result, the objective of the present systematic review and meta-analysis was to identify and quantify the magnitude of modifiable and non-modifiable risk factors for symptomatic and structural knee OA following trauma.
Of 5621 identified records, 66 randomized controlled trials and cohort studies (n=873,785) were included in the final analysis between 2000 and 2021. Studies were included if they assessed a potential risk factor for OA for a minimum of 2-years after a traumatic knee injury. Studies that did not report knee trauma were excluded. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. Data analysis was performed using random effects models as well as semiquantitative synthesis. Assessment for prognostic factors was performed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results demonstrated that moderate certainty evidence suggested that collateral ligament, cruciate ligament, chondral, meniscal, patellar/tibiofemoral dislocation, fracture and multistructure injuries may increase the odds of symptomatic osteoarthritis (OA). Furthermore, there is a lack of high-certainty evidence for modifiable risk factors for OA after traumatic injury, unlike for non-traumatic OA. Despite these results, this study was limited as the odds of OA may have been underestimated by including data from early timepoints when structural changes and/or symptoms were less prevalent. Nonetheless, the present study represents the most extensive synthesis, analysis, and presentation of potential risk factors for OA after knee trauma to date.
Click to read the study in British Journal of Sports Medicine
Image: PD
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