title: Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood.
abstract: OBJECTIVE
  To estimate the lifetime risk of knee osteoarthritis (OA) and total knee replacement (TKR) in persons sustaining anterior cruciate ligament (ACL) tear by age 25 years.
  
  
  METHODS
  We used the Osteoarthritis Policy Model to project the cumulative incidence of symptomatic knee OA requiring TKR in varying situations: no prevalent or incident injury; isolated ACL tear, surgically treated; isolated ACL tear, nonoperatively treated; or a prevalent history or surgically treated ACL and meniscal tear (MT). We estimated MT prevalence and incidence and increased risk of knee OA associated with ACL injury and MT from published literature. We conducted a range of sensitivity analyses to examine the impact of uncertainty in input parameters.
  
  
  RESULTS
  Estimated lifetime risk of symptomatic knee OA was 34% for the cohort with ACL injury and MT, compared to 14% for the no-injury cohort. ACL injury without MT was associated with a lifetime risk of knee OA between 16% and 17%, depending on ACL treatment modality. Estimated lifetime risk of TKR ranged from 6% in the no-injury cohort to 22% for the ACL injury and MT cohort. Subjects in the ACL injury and MT cohort developed OA approximately 1.5 years earlier (55.7 versus 57.1) and underwent TKR approximately 2 years earlier (66 versus 68) than the cohort without knee injuries.
  
  
  CONCLUSIONS
  Sustaining ACL injury early in adulthood leads to greater lifetime risk and earlier onset of knee OA and TKR; concomitant MTs compound this risk. These data provide insight into the impact of sustainable injury prevention interventions in young adults.
authors.affiliation: Yale School of Medicine, Yale New Haven Health Services Corporation Center for Outcome Research and Evaluation, and VA Connecticut Healthcare System, West Haven.
authors.forename: Lisa G
authors.initials: LG
authors.lastname: Suter
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Savannah R
authors.initials: SR
authors.lastname: Smith
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Katz
authors.affiliation: Lund University, Lund, Sweden, and Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0003-3320-2437
authors.initials: M
authors.lastname: Englund
authors.affiliation: University of Sydney and Royal North Shore Hospital, Sydney, New South Wales, Australia.
authors.forename: David J
authors.identifier: http://orcid.org/0000-0003-3197-752X
authors.initials: DJ
authors.lastname: Hunter
authors.affiliation: Lund University, Lund, Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Frobell
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, and Boston University School of Public Health, Boston, Massachusetts.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
mesh_terms: D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications*; D059549:Anterior Cruciate Ligament Reconstruction; D019645:Arthroplasty, Replacement, Knee; D015331:Cohort Studies; D003198:Computer Simulation; D005260:Female; D006801:Humans; D008297:Male; D020370:Osteoarthritis, Knee / Q000453:epidemiology* / Q000209:etiology; D012306:Risk; D055815:Young Adult