90 Management of gluteal tendinopathy: a systematic review with meta-analysis of all interventions

Abstract

risk factors underwent semi-quantitative synthesis. The GRADE approach for prognostic factors guided assessment. Results Across 66 included studies, 81 unique risk factors were identified. 64% and 49% of studies had high risk-of-bias from attrition and confounding. Semi-quantitative syntheses identified limited high-quality evidence that cruciate ligament, collateral ligament, meniscal, chondral, dislocation, fracture, and multi-structure injuries increase symptomatic osteoarthritis odds. Ten risk factors for structural osteoarthritis underwent meta-analysis (sex, rehabilitation for ACL tear, ACL reconstruction (ACLR), ACLR age, ACLR body-mass-index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low quality evidence suggests increased odds of structural osteoarthritis related to ACLR+cartilage injury (OR=2.31; 95%CI 1.35,3.94), ACLR+partial meniscectomy (OR=1.87; 1.45,2.42), and ACLR+total medial meniscectomy (OR=3.14; 2.20,4.48). Conclusion Limited high-quality evidence suggests that various knee injury types (not just ACL tears) increase symptomatic osteoarthritis. Risk factor heterogeneity, low-quality evidence, and inconsistency in risk factor and osteoarthritis definition make identifying modifiable targets for preventing symptomatic post-traumatic knee osteoarthritis challenging.