Who’s at Risk?

Abstract

The development of osteoarthritis following anterior cruciate ligament (ACL) injury reconstruction is a well-documented and vexing problem. Although much of the existing literature relies on the detection of radiographic signs of osteoarthritis to quantify osteoarthritis risk, the authors of the current study have utilized a different approach. Relying on billing data in a single-payer health-care system, they identified patients who had undergone cruciate ligament reconstruction and a matched control group. They then compared the risk of subsequent knee arthroplasty between these populations and attempted to identify additional risk factors for knee arthroplasty in the cruciate ligament reconstruction group. Perhaps not surprisingly, given the abundance of literature demonstrating rather high osteoarthritis risk after ACL injury and reconstruction, Leroux and colleagues noted an increased (sevenfold) cumulative incidence of knee arthroplasty among those who had undergone cruciate ligament reconstruction. Unfortunately, because of the limitations of their study design and data set, they had no data regarding other factors that may contribute to the risk of subsequent knee arthroplasty beyond those that were matched (age, sex, income, address, and comorbidities). Perhaps the most important …