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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)
  1. Tanvir Khan1,
  2. Abtin Alvand2,
  3. Daniel Prieto-Alhambra2,3,
  4. David J Culliford4,
  5. Andrew Judge2,3,
  6. William F Jackson2,
  7. Brigitte E Scammell1,
  8. Nigel K Arden2,3,
  9. Andrew James Price2
  1. 1Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  3. 3MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
  4. 4NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
  1. Correspondence to Mr. Tanvir Khan, Academic Orthopaedics, Trauma & Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham NG72UH, UK; tanvir.khan{at}


Objectives The aim of this study was to investigate whether ACL injury (ACLi) or meniscal injury increases the risk of end-stage osteoarthritis (OA) resulting in total knee replacement (TKR).

Methods A matched case–control study of all TKRs performed in the UK between January 1990 and July 2011 and recorded in the Clinical Practice Research Datalink (CPRD) was undertaken. The CPRD contains longitudinal data on approximately 3.6 million patients. Two controls were selected for each case of TKR, matched on age, sex and general practitioner location as a proxy for socioeconomic status. Individuals with inflammatory arthritis were excluded. The odds of having TKR for individuals with a CPRD-recorded ACLi were compared with those without ACLi using conditional logistic regression, after adjustment for body mass index, previous knee fracture and meniscal injury. The adjusted odds of TKR in individuals with a recorded meniscal injury compared with those without were calculated.

Results After exclusion of individuals with inflammatory arthritis, there were 49 723 in the case group and 104 353 controls. 153 (0.31%) cases had a history of ACLi compared with 41 (0.04%) controls. The adjusted OR of TKR after ACLi was 6.96 (95% CI 4.73 to 10.31). 4217 (8.48%) individuals in the TKR group had a recorded meniscal injury compared with 669 (0.64%) controls. The adjusted OR of TKR after meniscal injury was 15.24 (95% CI 13.88 to 16.69).

Conclusion This study demonstrates that ACLi is associated with a sevenfold increased odds of TKR resulting from OA. Meniscal injury is associated with a 15-fold increase odds of TKR for OA.

  • acl
  • meniscus
  • knee injuries
  • osteoarthritis

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  • Contributors All authors listed fulfil the ICMJE recommendations (2013) for authorship based on four criteria: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data for the work; drafting the work or revising it critically for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The study was funded by ARUK Centre for Sport, Exercise and Osteoarthritis and NIHR Academic Clinical Fellowship Award.

  • Competing interests None declared.

  • Ethics approval Approval was obtained prior to commencement of this study from the Independent Scientific Advisory Committee of the Clinical Practice Research Datalink.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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