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
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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)