Cruciate ligament reconstruction and risk of knee osteoarthritis: the association between cruciate ligament injury and post-traumatic osteoarthritis. a population based nationwide study in Sweden, 1987-2009

PLoS One. 2014 Aug 22;9(8):e104681. doi: 10.1371/journal.pone.0104681. eCollection 2014.


Objective: To study the association between Cruciate Ligament (CL) injury and development of post-traumatic osteoarthritis in the knee in patients treated operatively with CL reconstruction compared with patients treated non-operatively.

Design: Population based cohort study; level of evidence II-2.

Setting: Sweden, 1987-2009.

Participants: All patients aged between 15-60 years being diagnosed and registered with a CL injury in The National Swedish Patient Register between 1987 and 2009.

Main outcome measures: Knee osteoarthritis.

Results: A total of 64,614 patients diagnosed with CL injury during 1987 to 2009 in Sweden were included in the study. Seven percent of the patients were diagnosed with knee OA in specialized healthcare during the follow-up (mean 9 years). Stratified analysis by follow-up showed that while those with shorter follow-up had a non-significant difference in risk (0.99, 95%CI 0.90-1.09 for follow-up less than five years compared with the non-operated cohort), those with longer follow-up had an increased risk of knee OA after CL reconstruction (HR = 1.42, 95%CI 1.27-1.58 for follow-up more than ten years compared with non-operated cohort). The risk to develop OA was not affected by sex.

Conclusion: CL reconstructive surgery does not seem to have a protective effect on long term OA in either men or women.

Publication types

  • Historical Article
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / surgery*
  • Anterior Cruciate Ligament Injuries
  • Cohort Studies
  • Follow-Up Studies
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Incidence
  • Middle Aged
  • Osteoarthritis, Knee / epidemiology*
  • Osteoarthritis, Knee / etiology*
  • Osteoarthritis, Knee / history
  • Plastic Surgery Procedures / adverse effects*
  • Population Surveillance
  • Posterior Cruciate Ligament / injuries
  • Posterior Cruciate Ligament / surgery*
  • Postoperative Complications
  • Registries
  • Risk
  • Sweden / epidemiology
  • Tibial Meniscus Injuries
  • Young Adult

Grant support

This study was fully funded by the Foundation of Martin Rind and by research funds from the Stockholm County Council and Karolinska Institutet,, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.