Association of Traumatic Knee Injury With Radiographic Evidence of Knee Osteoarthritis in Military Officers

Abstract

Objective The association between knee injury and knee osteoarthritis (OA) is understudied relative to its importance, particularly in younger populations. This study was undertaken to examine the association of knee injury with radiographic features of knee OA in military officers, who have a physically demanding profession and high rates of knee injury. Methods Participants were recruited in 2015–2017 from an existing program that enrolled 6,452 military officers during 2004–2009. Officers with a history of knee ligament or meniscal injuries (n = 117 via medical record review) were compared to officers with no history of knee injury (n = 143). Bilateral posteroanterior knee radiographs were obtained using a standardized fixed‐flexion positioning frame. All images were read for Kellgren/Lawrence (K/L) grade, osteophyte (OST), and joint space narrowing (JSN) scores. Data were analyzed using linear‐risk regression models with generalized estimating equations. Results Injured and noninjured participants were similar (mean age 28 years, mean body mass index 25 kg/m2, ~40% female). The mean time from first knee injury to imaging among injured participants was 9.2 years. Compared with noninjured knees, greater prevalence of radiographic OA (K/L grade ≥ 2), OST (grade ≥ 1), and JSN (grade ≥ 1) was observed among injured knees, with prevalence differences of +16% (95% confidence interval [95% CI] 10%, 22%), +29% (95% CI 20%, 38%), and + 17% (95% CI 10%, 24%), respectively. Approximately 1 in 6 officers with prior knee injury progressed to radiographic OA by age 30 years. Conclusion At the midpoint of a projected 20‐year military career, officers with a history of traumatic knee injury have a markedly increased prevalence of knee radiographic OA compared to officers without injury.

Increased risk of lower limb osteoarthritis among former professional soccer (football) players

“…Trauma resulting from sports participation has been linked with the subsequent development of OA [ 32 , 33 ], which may be an underlying risk factor in this cohort. Currently, medical interventions are mostly symptomatic, and are inadequate to prevent the development of OA, or to dramatically improve pre-existing OA.…”

Osteoarthritis in the UK Armed Forces: a review of its impact, treatment and future research

“…The current key research priorities are to understand pathophysiological mechanisms, earlier recognition and diagnosis, and optimalisation of prevention and management strategies (particularly relevant for PTOA, as the index trauma should initiate preventative interventions). [7,[10][11]25] A particular challenge in the research, and clinical, fields relate to the significant discordance between imaging (radiographic or structural OA), knee pain (symptomatic OA), and a physiciandiagnosed OA, a result of the poorly understood interactions between risk and individual factors (Figure 1). A recent US military study showed less than half of those with radiological OA reported symptoms.…”

“…A recent US military study showed less than half of those with radiological OA reported symptoms. [10] Another way to frame this discordance is to describe either the OA disease (underlying pathophysiology and cellular biology) or the OA illness (an individual's feeling or experience, characterised by symptoms, function and quality of life). [11] Regardless of terminology used, this phenomenon has implications for the design of clinical research studies, understanding pathways and markers associated with disability, dysfunction and pain, as well as future OA diagnostic criteria.…”

“…[8][9] In addition, a distinct subtype, post-traumatic osteoarthritis (PTOA), is common in military populations due to increased exposure to major or repeated micro trauma. [4,10] Due to its accelerated pathophysiological process and typical manifestation in the third or fourth decade, PTOA can have a long-lasting impact on individuals and their occupations. [11] A recent study showed that, following a knee injury, 1 in 6 US Military Officers developed OA by age 30.…”

“…[11] A recent study showed that, following a knee injury, 1 in 6 US Military Officers developed OA by age 30. [10] The purpose of this paper is to highlight OA, specifically PTOA, as an important diagnosis to consider in the military population to improve awareness and appropriate diagnosis, suggest current and future management options, and introduce current research trends.…”