Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database

PLOS ONE, Dec 2019

Objective This study aimed to support the potential protective role of anterior cruciate ligament (ACL) reconstruction against the development of osteoarthritis (OA). Methods In this retrospective cohort study, the long-term results of ACL reconstruction in Taiwan were evaluated based on data from the National Health Insurance Research Database (NHIRD). In total, 8,769 eligible cases were included from 11,921 ACL-injured patients. The cumulative incidence rates of OA and total knee replacement (TKR) were analyzed using the Kaplan-Meier estimator. Cox proportional hazards models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of OA. Results There was a lower cumulative incidence of OA among ACL-reconstructed patients (271, 33.1%) than among non-reconstructed patients (1,874, 40.3%; p < 0.001). Patients who underwent ACL reconstruction had a lower cumulative incidence of TKR during the follow-up period (0.6%) than the non-reconstructed patients (4.6%, p < 0.001). After adjusting for covariates, ACL-injured patients who underwent reconstruction within one month after ACL injury showed a significantly lower risk of OA than those who never underwent reconstruction (adjusted HR = 0.83, 95% CI = 0.69–0.99). Conclusions These results indicate that ACL reconstruction might not provide complete protection from OA development after traumatic knee injury but does yield a lower cumulative incidence of OA development and TKR. Moreover, based on the present study, ACL-injured patients should undergo reconstruction as early as possible (within one month) to lower the risk of OA.

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Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database

May Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database Sheng-Hsiung Lin 0 1 Ting-Chuan Wang 1 Chun-Fu Lai 1 Ru-Yin Tsai 1 Chih-Ping Yang 1 Chih-Shung Wong 0 1 2 0 Graduate Institute of Medical Science, National Defense Medical Center , Taipei, Taiwan , 2 Department of Medical Research, Cathay General Hospital , Taipei, Taiwan , 3 Division of Occupational Medicine, Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center , Taipei, Taiwan , 4 Department of Family Medicine, Tri-Service General Hospital Songshan Branch, National Defense Medical Center , Taipei, Taiwan , 5 Department of Nursing, Da-Yeh University , Changhua, Taiwan , 6 Division of Anesthesiology, Armed Forces Taoyuan General Hospital , Taoyuan , Taiwan 1 Editor: Ara Nazarian, Harvard Medical School/ BIDMC , UNITED STATES 2 Department of Anesthesiology, Cathay General Hospital , Taipei, Taiwan , 8 School of Medicine, Fu-Jen Catholic University , New Taipei , Taiwan - Data Availability Statement: This study is based in part on data obtained from the NHIRD provided from the NHIA and the Ministry of Health and Welfare and managed through the National Health Research Institutes. The interpretation and conclusions contained herein do not represent those of the NHIA, Ministry of Health and Welfare or National Health Research Institutes. This study was approved by the Institutional Review Board of Cathay General Hospital, Taipei, Taiwan. All personal identifiers in the NHIRD files from the NHI Objective Methods This study aimed to support the potential protective role of anterior cruciate ligament (ACL) reconstruction against the development of osteoarthritis (OA). In this retrospective cohort study, the long-term results of ACL reconstruction in Taiwan were evaluated based on data from the National Health Insurance Research Database (NHIRD). In total, 8,769 eligible cases were included from 11,921 ACL-injured patients. The cumulative incidence rates of OA and total knee replacement (TKR) were analyzed using the Kaplan-Meier estimator. Cox proportional hazards models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of OA. Results There was a lower cumulative incidence of OA among ACL-reconstructed patients (271, 33.1%) than among non-reconstructed patients (1,874, 40.3%; p < 0.001). Patients who underwent ACL reconstruction had a lower cumulative incidence of TKR during the followup period (0.6%) than the non-reconstructed patients (4.6%, p < 0.001). After adjusting for covariates, ACL-injured patients who underwent reconstruction within one month after ACL injury showed a significantly lower risk of OA than those who never underwent reconstruction (adjusted HR = 0.83, 95% CI = 0.69±0.99). program were removed before the data were released for this analysis. Therefore, it was impossible for the authors to identify individual data in the database. Data inquiries may be directed to . Funding: This study was funded through a grant from the Cathay General Hospital, Taipei, Taiwan (CGH-MR-A10307). Competing interests: The authors have declared that no competing interests exist. Conclusions These results indicate that ACL reconstruction might not provide complete protection from OA development after traumatic knee injury but does yield a lower cumulative incidence of OA development and TKR. Moreover, based on the present study, ACL-injured patients should undergo reconstruction as early as possible (within one month) to lower the risk of OA. Introduction Epidemiological studies have found that a history of knee injury is associated with an increased risk of osteoarthritis (OA) [ 1 ]. A long-term follow-up study reported that people with a knee injury had at least a 5-fold increased risk of developing knee OA [ 2 ]. One of the most common knee injuries is anterior cruciate ligament (ACL) injury, for which reconstruction is frequently performed [3±5]. Previous studies have reported an annual incidence of ACL injury in the general population of 0.8 per 1,000 [ 6 ]. Each year, more than 100,000 new cases of ACL injury occur, and approximately 75,000 ACL reconstructions are performed in the United States [ 7 ]. Knee OA often develops after ACL injury [ 8 ]. Studies have reported rates of radiographic tibiofemoral OA as high as 13% for isolated ACL injuries and from 21% to 48% for subjects with combined ACL and meniscal injuries more than 10 years after the injury [ 9 ]. However, few Taiwan-based population references are available. OA is a major cause of disabilities in people aged 65 years and older; current estimates suggest that 40 million people in the United States have OA, and this number increases annually [ 10 ]. Similar trends are occurring in Taiwan. Before 1994, health workers in Taiwan conducted a preteste (...truncated)


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Sheng-Hsiung Lin, Ting-Chuan Wang, Chun-Fu Lai, Ru-Yin Tsai, Chih-Ping Yang, Chih-Shung Wong. Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database, PLOS ONE, 2017, Volume 12, Issue 5, DOI: 10.1371/journal.pone.0178292