Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction

Bodkin SG, Werner BC, Slater LV, and Hart JM. Knee Surg Sports Traumatol Arthrosc. 2019. [Epub Ahead of Print].

Take Home Message: Almost 1 in 8 patients seek medical care and are diagnosed with knee osteoarthritis within 5 years of an anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) rupture can lead to long-term changes in joint health and greatly affect an person’s short- and long-term quality of life. However, most studies have relied on sending surveys or inviting former patients back for an evaluation. Few studies have used large samples of healthcare data to identify people who are diagnosed with symptomatic knee osteoarthritis and seeking medical care. Therefore, Bodkin and colleagues completed an analysis of a national insurance-based, for-fee database of patient records to calculate the incidence of osteoarthritis following an ACL reconstruction and examine the risk factors related with osteoarthritis development. Researchers queried the database based on procedure codes (CPT) and diagnosis codes (ICD-9). The database includes data from both Medicare and private insurance companies. The authors identified patients who underwent arthroscopic ACL reconstruction and were given a diagnosis of knee osteoarthritis. They excluded patients with a diagnosis of osteoarthritis prior to the ACL reconstruction. A total of 517 (12%) patients had ACLR and a diagnosis of OA post-surgery within 5 years of surgery. Risk factors for a new OA diagnosis were an age of greater than 35 years old, female sex, morbid obesity, tobacco use, and meniscal surgery at the time of an ACL reconstruction (partial meniscectomy or repair).

The authors found that almost 1 in 8 patients seek medical care and are diagnosed with knee osteoarthritis within 5 years of an ACL reconstruction. These findings complement prior findings that 1 in 3 patients will have radiographic knee osteoarthritis (with or without symptoms) within 10 years of an ACL reconstruction. This study was unique because the authors used a large set of data from insurance companies. While the data source in the study is unique, it does have some limitations which should be noted. Most importantly, the database lacks data on the type of ACL reconstruction, rehabilitation following ACL reconstruction, and how the diagnosis of osteoarthritis was obtained. These factors along with others could impact how we should interpret the data. Despite this limitation, clinicians can use these findings to educate patients and identify patients who are at an elevated risk for the development of knee osteoarthritis (e.g., morbidly obese, adults over 35 years of age). Clinicians should have discussions – especially with patients at high risk – during the rehabilitation phase about what signs and symptoms they should watch out for and when they should notify a healthcare provider about concerns.

Questions for Discussion: Are you surprised by this prevalence rate of knee OA? Why or why not?

Written by: Kyle Harris

Reviewed by: Jeffrey Driban

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