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Risk of knee osteoarthritis after different types of knee injuries in young adults: a population-based cohort study
  1. Barbara Snoeker1,
  2. Aleksandra Turkiewicz1,
  3. Karin Magnusson1,2,
  4. Richard Frobell3,
  5. Dahai Yu4,
  6. George Peat4,
  7. Martin Englund1
  1. 1Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Faculty of Medicine, Lund, Sweden
  2. 2Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  3. 3Clinical Sciences Lund, Orthopaedics, Lund University, Faculty of Medicine, Lund, Sweden
  4. 4Research Institute for Primary Care & Health Sciences, Keele University, Keele, Staffordshire, UK
  1. Correspondence to Dr Barbara Snoeker, Clinical Sciences, Lunds University Faculty of Medicine, Lund 22185, Sweden; barbara.snoeker{at}


Objectives To estimate the risk of clinically diagnosed knee osteoarthritis (OA) after different types of knee injuries in young adults.

Methods In a longitudinal cohort study based on population-based healthcare data from Skåne, Sweden, we included all persons aged 25–34 years in 1998–2007 (n=149 288) with and without diagnoses of knee injuries according to International Classification of Diseases (ICD)-10. We estimated the HR of future diagnosed knee OA in injured and uninjured persons using Cox regression, adjusted for potential confounders. We also explored the impact of type of injury (contusion, fracture, dislocation, meniscal tear, cartilage tear/other injury, collateral ligament tear, cruciate ligament tear and injury to multiple structures) on diagnosed knee OA risk.

Results We identified 5247 persons (mean (SD) age 29.4 (2.9) years, 67% men) with a knee injury and 142 825 persons (mean (SD) age 30.2 (3.0) years, 45% men) without. We found an adjusted HR of 5.7 (95% CI 5.0 to 6.6) for diagnosed knee OA in injured compared with uninjured persons during the first 11 years of follow-up and 3.4 (95% CI 2.9 to 4.0) during the following 8 years. The corresponding risk difference (RD) after 19 years of follow-up was 8.1% (95% CI 6.7% to 9.4%). Cruciate ligament injury, meniscal tear and fracture of the tibia plateau/patella were associated with greatest increase in risk (RD of 19.6% (95% CI 13.2% to 25.9%), 10.5% (95% CI 6.4% to 14.7%) and 6.6% (95% CI 1.1% to 12.2%), respectively).

Conclusion In young adults, knee injury increases the risk of future diagnosed knee OA about sixfold with highest risks found after cruciate ligament injury, meniscal tear and intra-articular fracture.

  • knee injuries
  • knee ACL
  • meniscus
  • fracture
  • osteoarthritis
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  • Contributors BS takes responsibility for the integrity of the data and the accuracy of the data analysis. BS performed statistical analyses and drafted the manuscript. AT, KM, RF, GP, DY and ME contributed with acquisition of data, conceptual design and analysis and interpretation of data. BS, AT, KM, RF, GP, DY and ME contributed in drafting the article or critically revising it for important intellectual content. All authors gave final approval for the version to be submitted.

  • Funding This study was funded by the Swedish Research Council, the Greta and Johan Kock Foundation, the Swedish Rheumatism Association, the Österlund Foundation, Governmental Funding of Clinical Research within the National Health Service (ALF).

  • Disclaimer The funding sources had no influence on the design or conduct of the study, the collection, management, analysis or interpretation of the data, the preparation, review or approval of the manuscript or the decision to submit the manuscript for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from Lund University ethics committee with ID number DNR 2011/432.

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

  • Data availability statement No data are available.

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