Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction

  • Stephan G. BodkinEmail author
  • Brian C. Werner
  • Lindsay V. Slater
  • Joseph M. Hart



The purpose was to calculate the incidence of osteoarthritis in individuals following Anterior Cruciate Ligament Reconstruction (ACLR) in a large, national database and to examine the risk factors associated with OA development.


A commercially available insurance database was queried to identify new diagnoses of knee OA in patients with ACLR. The cumulative incidence of knee OA diagnoses in patients after ACLR was calculated and stratified by time from reconstruction. Odds ratios were calculated using logistic regression to describe factors associated with a new OA diagnosis including age, sex, BMI, meniscus involvement, osteochondral graft use, and tobacco use.


A total of 10,565 patients with ACLR were identified that did not have an existing diagnosis of OA, 517 of which had a documented new diagnosis of knee OA 5 years after ACL reconstruction. When stratified by follow-up time points, the incidence of a new OA diagnosis within 6 months was 2.3%; within a 1-year follow-up was 4.1%; within 2 years, follow-up was 6.2%, within 3 years, follow-up was 8.4%; within 4 years, follow-up was 10.4%; and within 5 years, follow-up was 12.3%. Risk factors for new OA diagnoses were age (OR 2.44, P < 0.001), sex (OR 1.2, P = 0.002), obesity (OR 1.4, P < 0.001), tobacco use (OR = 1.3, P = 0.001), and meniscal involvement (OR 1.2, P = 0.005).


Approximately 12% of patients presenting within 5 years following ACLR are diagnosed with OA. Demographic factors associated with an increased risk of a diagnosis of PTOA within 5 years after ACLR are age, sex, BMI, tobacco use, and concomitant meniscal surgery. Clinicians should be cognizant of these risk factors to develop risk profiles in patients with the common goal to achieve optimal long-term outcomes after ACLR.

Level of evidence



ACL reconstruction Knee injury Post-traumatic osteoarthritis Outcomes Risk factors 



This study was not externally funded.

Compliance with ethical standards

Conflict of interest

Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Ethical approval

All data from PearlDiver are de-identified and anonymous and were, thus, deemed exempt by the University’s Institutional Review Board.


  1. 1.
    Anderson DD, Chubinskaya S, Guilak F, Martin JA, Oegema TR, Olson SA et al (2011) Post-traumatic osteoarthritis: improved understanding and opportunities for early intervention. J Orthop Res 29:802–809CrossRefGoogle Scholar
  2. 2.
    Ardern CL, Webster KE, Taylor NF, Feller JA (2011) Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med 45:596–606CrossRefGoogle Scholar
  3. 3.
    Barenius B, Ponzer S, Shalabi A, Bujak R, Norlen L, Eriksson K (2014) Increased risk of osteoarthritis after anterior cruciate ligament reconstruction: a 14-year follow-up study of a randomized controlled trial. Am J Sports Med 42:1049–1057CrossRefGoogle Scholar
  4. 4.
    Berenbaum F, Eymard F, Houard X (2013) Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol 25:114–118CrossRefGoogle Scholar
  5. 5.
    Blagojevic M, Jinks C, Jeffery A, Jordan KP (2010) Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthr Cartil 18:24–33CrossRefGoogle Scholar
  6. 6.
    Blyth MJG, Gosal HS, Peake WM, Bartlett RJ (2003) Anterior cruciate ligament reconstruction in patients over the age of 50 years: 2- to 8-year follow-up. Knee Surg Sports Traumatol Arthrosc 11:204–211CrossRefGoogle Scholar
  7. 7.
    Brown TD, Johnston RC, Saltzman CL, Marsh JL, Buckwalter JA (2006) Posttraumatic osteoarthritis: a first estimate of incidence, prevalence, and burden of disease. J Orthop Trauma 20:739–744CrossRefGoogle Scholar
  8. 8.
    Chockalingam PS, Glasson SS, Lohmander LS (2013) Tenascin-C levels in synovial fluid are elevated after injury to the human and canine joint and correlate with markers of inflammation and matrix degradation. Osteoarthr Cartil 21:339–345CrossRefGoogle Scholar
  9. 9.
    Cinque ME, Dornan GJ, Chahla J, Moatshe G, LaPrade RF (2017) High rates of osteoarthritis develop after anterior cruciate ligament surgery: an analysis of 4108 patients. Am J Sports Med 46(8):2011– 2019CrossRefGoogle Scholar
  10. 10.
    Collins JE, Katz JN, Donnell-Fink LA, Martin SD, Losina E (2013) Cumulative incidence of ACL reconstruction after ACL injury in adults role of age, sex, and race. Am J Sports Med 41:544–549CrossRefGoogle Scholar
  11. 11.
    Cooper C, Inskip H, Croft P, Campbell L, Smith G, McLaren M et al (1998) Individual risk factors for hip osteoarthritis: obesity, hip injury and physical activity. Am J Epidemiol 147:516–522CrossRefGoogle Scholar
  12. 12.
    Cox CL, Huston LJ, Dunn WR, Reinke EK, Nwosu SK, Parker RD et al (2014) Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study. Am J Sports Med 42:1058–1067CrossRefGoogle Scholar
  13. 13.
    Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M et al (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73:1323–1330CrossRefGoogle Scholar
  14. 14.
    Dekker TJ, Godin JA, Dale KM, Garrett WE, Taylor DC, Riboh JC (2017) Return to sport after pediatric anterior cruciate ligament reconstruction and its effect on subsequent anterior cruciate ligament injury. J Bone Joint Surg 99:897–904CrossRefGoogle Scholar
  15. 15.
    Desai N, Bjornsson H, Samuelsson K, Karlsson J, Forssblad M (2014) Outcomes after ACL reconstruction with focus on older patients: results from The Swedish National Anterior Cruciate Ligament Register. Knee Surg Sports Traumatol Arthrosc 22:379–386CrossRefGoogle Scholar
  16. 16.
    Dudhia J (2005) Aggrecan, aging and assembly in articular cartilage. Cell Mol Life Sci 62:2241–2256CrossRefGoogle Scholar
  17. 17.
    Englund M, Lohmander LS: Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 50:2811–2819Google Scholar
  18. 18.
    Felson DT, Goggins J, Niu JB, Zhang YQ, Hunter DJ (2004) The effect of body weight on progression of knee osteoarthritis is dependent on alignment. Arthritis Rheum 50:3904–3909CrossRefGoogle Scholar
  19. 19.
    Felson DT, Zhang YQ, Hannan MT, Naimark A, Weissman B, Aliabadi P et al (1997) Risk factors for incident radiographic knee osteoarthritis in the elderly—the Framingham study. Arthritis Rheum 40:728–733CrossRefGoogle Scholar
  20. 20.
    Harris K, Driban JB, Sitler MR, Cattano NM, Hootman JM (2015) Five-year clinical outcomes of a randomized trial of anterior cruciate ligament treatment strategies: an evidence-based practice paper. J Athl Train 50:110–112CrossRefGoogle Scholar
  21. 21.
    Heijink A, Gomoll AH, Madry H, Drobnic M, Filardo G, Espregueira-Mendes J et al (2012) Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc 20:423–435CrossRefGoogle Scholar
  22. 22.
    Jiang LY, Tian WJ, Wang YC, Rong JS, Bao CD, Liu YP et al (2012) Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis. Jt Bone Spine 79:291–297CrossRefGoogle Scholar
  23. 23.
    Joseph AM, Collins CL, Henke NM, Yard EE, Fields SK, Comstock RD (2013) A multisport epidemiologic comparison of anterior cruciate ligament injuries in high school athletics. J Athl Train 48:810–817CrossRefGoogle Scholar
  24. 24.
    Khan T, Alvand A, Prieto-Alhambra D, Culliford DJ, Judge A, Jackson WF et al (2018) ACL and meniscal injuries increase the risk of primary total knee replacement for osteoarthritis: a matched case-control study using the Clinical Practice Research Datalink (CPRD). Br J Sports Med. Google Scholar
  25. 25.
    Lohmander LS, Englund PM, Dahl LL, Roos EM (2007) The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med 35:1756–1769CrossRefGoogle Scholar
  26. 26.
    Lohmander LS, Ostenberg A, Englund M, Roos H (2004) High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum 50:3145–3152CrossRefGoogle Scholar
  27. 27.
    Losina E, Weinstein AM, Reichmann WM, Burbine SA, Solomon DH, Daigle ME et al (2013) Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US. Arthritis Care Res (Hoboken) 65:703–711CrossRefGoogle Scholar
  28. 28.
    Magnussen RA, Borchers JR, Pedroza AD, Huston LJ, Haas AK, Spindler KP et al (2018) Risk factors and predictors of significant chondral surface change from primary to revision anterior cruciate ligament reconstruction a MOON and MARS cohort study. Am J Sports Med 46:557–564CrossRefGoogle Scholar
  29. 29.
    Mall NA, Chalmers PN, Moric M, Tanaka MJ, Cole BJ, Bach BR Jr et al (2014) Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 42:2363–2370CrossRefGoogle Scholar
  30. 30.
    Melton JTK, Murray JR, Karim A, Pandit H, Wandless F, Thomas NP (2011) Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study. Knee Surg Sports Traumatol Arthrosc 19:1729–1734CrossRefGoogle Scholar
  31. 31.
    Mihata LCS, Beutler AI, Boden BP (2006) Comparing the incidence of anterior cruciate ligament injury in collegiate lacrosse, soccer, and basketball players—implications for anterior cruciate ligament mechanism and prevention. Am J Sports Med 34:899–904CrossRefGoogle Scholar
  32. 32.
    Nordenvall R, Bahmanyar S, Adami J, Mattila VM, Fellander-Tsai L (2014) Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. A population based nationwide study in Sweden, 1987–2009. Plos One 9:7CrossRefGoogle Scholar
  33. 33.
    Oiestad BE, Holm I, Engebretsen L, Aune AK, Gunderson R, Risberg MA (2013) The prevalence of patellofemoral osteoarthritis 12 years after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:942–949CrossRefGoogle Scholar
  34. 34.
    Roos H, Adalberth T, Dahlberg L, Lohmander LS (1995) Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthr Cartil 3:261–267CrossRefGoogle Scholar
  35. 35.
    Sanders TL, Kremers HM, Bryan AJ, Larson DR, Dahm DL, Levy BA et al (2016) Incidence of anterior cruciate ligament tears and reconstruction: a 21-year population-based study. Am J Sports Med 44:1502–1507CrossRefGoogle Scholar
  36. 36.
    Schmitt LC, Paterno MV, Hewett TE (2012) The impact of quadriceps femoris strength asymmetry on functional performance at return to sport following anterior cruciate ligament reconstruction. J Orthop Sports Phys Ther 42:750–759CrossRefGoogle Scholar
  37. 37.
    Sharma L, Lou C, Cahue S, Dunlop DD (2000) The mechanism of the effect of obesity in knee osteoarthritis—the mediating role of malalignment. Arthritis Rheum 43:568–575CrossRefGoogle Scholar
  38. 38.
    Spindler KP, Huston LJ, Wright RW, Kaeding CC, Marx RG, Amendola A et al (2011) The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction a population cohort study. Am J Sports Med 39:348–359CrossRefGoogle Scholar
  39. 39.
    Thomas AC, Hubbard-Turner T, Wikstrom EA, Palmieri-Smith RM (2017) Epidemiology of posttraumatic osteoarthritis. J Athl Train 52:491–496CrossRefGoogle Scholar
  40. 40.
    Tourville TW, Johnson RJ, Slauterbeck JR, Naud S, Beynnon BD (2013) Assessment of early tibiofemoral joint space width changes after anterior cruciate ligament injury and reconstruction a matched case-control study. Am J Sports Med 41:769–778CrossRefGoogle Scholar
  41. 41.
    von Porat A (2004) High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis 63:269–273CrossRefGoogle Scholar
  42. 42.
    Zhang YQ, Jordan JM (2010) Epidemiology of osteoarthritis. Clin Geriatr Med 26:355–369CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of KinesiologyUniversity of VirginiaCharlottesvilleUSA
  2. 2.Department of Orthopaedic SurgeryUniversity of Virginia Health SystemCharlottesvilleUSA
  3. 3.Shirley Ryan AbilityLabChicagoUSA

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