Knee osteoarthritis risk is increased 4-6 fold after knee injury: a systematic review and meta-analysis

Erik Poulsen* (Corresponding Author), Glaucia H. Goncalves, Alessio Bricca, Ewa M. Roos, Jonas B. Thorlund, Carsten B. Juhl

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

136 Citations (Scopus)


OBJECTIVE: To estimate knee osteoarthritis (OA) risk following anterior cruciate ligament (ACL), meniscus or combined ACL and meniscus injury.

DESIGN: Systematic review and meta-analysis.

DATA SOURCES: MEDLINE, Embase, SPORTDiscus, CINAHL and Web of Science until November 2018.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Prospective or retrospective studies with at least 2-year follow-up including adults with ACL injury, meniscal injury or combined injuries. Knee OA was defined by radiographs or clinical diagnosis and compared with the contralateral knee or non-injured controls.

STUDY APPRAISAL AND SYNTHESIS: Risk of bias was assessed using the SIGN50 checklist. ORs for developing knee OA were estimated using random effects meta-analysis.

RESULTS: 53 studies totalling ∼1 million participants were included: 185 219 participants with ACL injury, mean age 28 years, 35% females, 98% surgically reconstructed; 83 267 participants with meniscal injury, mean age 38 years, 36% females, 22% confirmed meniscectomy and 73% unknown; 725 362 participants with combined injury, mean age 31 years, 26% females, 80% treated surgically. The OR of developing knee OA were 4.2 (95% CI 2.2 to 8.0; I2=92%), 6.3 (95% CI 3.8 to 10.5; I2=95%) and 6.4 (95% CI 4.9 to 8.3; I2=62%) for patients with ACL injury, meniscal injury and combined injuries, respectively.

CONCLUSION: The odds of developing knee OA following ACL injury are approximately four times higher compared with a non-injured knee. A meniscal injury and a combined injury affecting both the ACL and meniscus are associated with six times higher odds compared with a non-injured knee. Large inconsistency (eg, study design, follow-up period and comparator) and few high-quality studies suggest that future studies may change these estimates.

CLINICAL RELEVANCE: Patients sustaining a major knee injury have a substantially increased risk of developing knee OA, highlighting the importance of knee injury prevention programmes and secondary prevention strategies to prevent or delay knee OA development.PROSPERO registration number CRD42015016900.

Original languageEnglish
Pages (from-to)1454-1463
Number of pages10
JournalBritish Journal of Sports Medicine
Issue number23
Early online date14 Nov 2019
Publication statusPublished - Dec 2019


  • anterior cruciate ligament
  • knee injuries
  • meniscus
  • meta-analysis
  • osteoarthritis


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