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Association between MRI-defined osteoarthritis, pain, function and strength 3–10 years following knee joint injury in youth sport
  1. Jackie L Whittaker1,2,3,
  2. Clodagh M Toomey3,
  3. Linda J Woodhouse1,
  4. Jacob L Jaremko4,
  5. Alberto Nettel-Aguirre3,5,6,7,
  6. Carolyn A Emery3,5,6,7
  1. 1 Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
  2. 2 Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada
  3. 3 Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
  4. 4 Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
  5. 5 The Alberta Children’s Hospital Research Institute for Child and Maternal Health, Calgary, Alberta, Canada
  6. 6 Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
  7. 7 Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Dr Jackie L Whittaker, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta T6G 2G4, Canada; jwhittak{at}


Background Youth and young adults who participate in sport have an increased risk of knee injury and subsequent osteoarthritis. Improved understanding of the relationship between structural and clinical outcomes postinjury could inform targeted osteoarthritis prevention interventions. This secondary analysis examines the association between MRI-defined osteoarthritis and self-reported and functional outcomes, 3–10 years following youth sport-related knee injury in comparison to healthy controls.

Methods Participants included a subsample (n=146) of the Alberta Youth Prevention of Early Osteoarthritis cohort: specifically, 73 individuals with 3–10years history of sport-related intra-articular knee injury and 73 age-matched, sex-matched and sport-matched controls with completed MRI studies. Outcomes included: MRI-defined osteoarthritis, radiographic osteoarthritis, Knee Injury and Osteoarthritis Outcome Score, Intermittent and Constant Osteoarthritis Pain, knee extensor/flexor strength, triple-hop and Y-balance test. Descriptive statistics and univariate logistic regression were used to compare those with and without MRI-defined osteoarthritis. Associations between MRI-defined osteoarthritis and each outcome were assessed using multivariable linear regression considering the influence of injury history, sex, body mass index and time since injury.

Results Participant median age was 23 years (range 15–27), and 63% were female. MRI-defined osteoarthritis varied by injury history, injury type and surgical history and was not isolated to participants with ACL and/or meniscal injuries. Those with a previous knee injury had 10-fold (95% CI 2.3 to 42.8) greater odds of MRI-defined osteoarthritis than uninjured participants. MRI-defined osteoarthritis was independently significantly associated with quality of life, but not symptoms, strength or function.

Summary MRI-detected structural changes 3– 10 years following youth sport-related knee injury may not dictate clinical symptomatology, strength or function but may influence quality of life.

  • adolescent
  • knee injuries
  • knee ACL
  • MRI
  • sport

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  • Contributors CAE, LJW, JLJ and JLW conceived and designed the study and obtained funding. JLW and CAE coordinated the study and managed all aspects including collection and assembly of the data. JLJ oversaw all diagnostic imaging. AN-A, CAE and JLW planned the analyses. JLW conducted all analyses and wrote the first draft of the manuscript. All authors contributed to the interpretation of the data and critical revision and approval of the final manuscript.

  • Funding The Alberta Youth Prevention of Early Osteoarthritis cohort is funded by the Canadian Institute of Health Research (MOP 133597), the Alberta Osteoarthritis Team supported by Alberta Innovates Health Solutions (AIHS) and the Alberta Children’s Hospital Foundation. The Sport Injury Prevention Research Centre is supported by an International Olympic Committee Research Centre Award. JLW and CMT were awarded AIHS Clinician Fellowships to support this cohort study.

  • Disclaimer The funders had no role in any part of the study or the decision to publish. All authors had full access to the data and take responsibility for data integrity and the accuracy of the analyses. The senior author (CAE) affirms that this manuscript is an honest, accurate and transparent account of the study being reported, that no important aspects of the study were omitted and that any discrepancies from the planned study have been explained.

  • Competing interests CAE is funded through a Chair in Pediatric Rehabilitation (Alberta Children’s Hospital Foundation). LJW has a consultation arrangement with Eli Lilly. The remaining authors have nothing to disclose.

  • Patient consent Obtained.

  • Ethics approval Conjoint Health Research Ethics Board, University of Calgary, Canada.

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