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What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review
  1. Marthe Mehus Lie1,
  2. May Arna Risberg2,3,
  3. Kjersti Storheim1,4,
  4. Lars Engebretsen3,5,
  5. Britt Elin Øiestad1
  1. 1 Institute of Physiotherapy, OsloMet – Oslo Metropolitan University, Oslo, Norway
  2. 2 Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
  3. 3 Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
  4. 4 Research and Communication unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway
  5. 5 Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  1. Correspondence to Dr Britt Elin Øiestad, Institute of Physiotherapy, OsloMet – Oslo Metropolitan University, Oslo, Norway; brielo{at}


Background This updated systematic review reports data from 2009 on the prevalence, and risk factors, for knee osteoarthritis (OA) more than 10 years after anterior cruciate ligament (ACL) tear.

Methods We systematically searched five databases (PubMed, EMBASE, AMED, Cinahl and SPORTDiscus) for prospective and retrospective studies published after 1 August 2008. Studies were included if they investigated participants with ACL tear (isolated or in combination with medial collateral ligament and/or meniscal injuries) and reported symptomatic and/or radiographic OA at a minimum of 10 years postinjury. We used a modified version of the Downs and Black checklist for methodological quality assessment and narrative synthesis to report results. The study protocol was registered in PROSPERO.

Results Forty-one studies were included. Low methodological quality was revealed in over half of the studies. At inclusion, age ranged from 23 to 38 years, and at follow-up from 31 to 51 years. Sample sizes ranged from 18 to 780 participants. The reported radiographic OA prevalence varied between 0% and 100% >10 years after injury, regardless of follow-up time. The studies with low and high methodological quality reported a prevalence of radiographic OA between 0%–100% and 1%–80%, respectively. One study reported symptomatic knee OA for the tibiofemoral (TF) joint (35%), and one study reported symptomatic knee OA for the patellofemoral (PF) joint (15%). Meniscectomy was the only consistent risk factor determined from the data synthesis.

Conclusion Radiographic knee OA varied between 0% and 100% in line with our previous systematic review from 2009. Symptomatic and radiographic knee OA was differentiated in two studies only, with a reported symptomatic OA prevalence of 35% for the TF joint and 15% for PF joint. Future cohort studies need to include measurement of symptomatic knee OA in this patient group.

PROSPERO registration number CRD42016042693.

  • anterior cruciate ligament
  • knee osteoarthritis
  • risk factor
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  • Contributors All coauthors have read, commented and reviewed at least two versions of the manuscript and the final draft. All coauthors have been involved in the quality assessments of the articles included in the systematic review. All coauthors agreed to update the systematic review with this design and the new added research question on symptomatic knee OA. MML and BEØ performed the systematic searches and selected articles for inclusion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Patient consent for publication Not required.

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