Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database
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...
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| Veröffentlicht in: | PloS one 2017-05, Vol.12 (5), p.e0178292-e0178292 |
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| creator | Lin, Sheng-Hsiung Wang, Ting-Chuan Lai, Chun-Fu Tsai, Ru-Yin Yang, Chih-Ping Wong, Chih-Shung |
| description | 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.
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).
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. |
| doi_str_mv | 10.1371/journal.pone.0178292 |
| format | Article |
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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.
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).
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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0178292</identifier><identifier>PMID: 28558029</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Age ; Aging ; Aging (artificial) ; Amino acids ; Analysis ; Anesthesiology ; Anterior cruciate ligament ; Anterior Cruciate Ligament Injuries - complications ; Anti-inflammatory agents ; Armed forces ; Arthritis ; Arthroplasty (knee) ; Arthroplasty, Replacement, Knee - adverse effects ; Arthroscopy ; Artificial joints ; Attenuation ; Biocompatibility ; Biology and Life Sciences ; Body mass ; Body mass index ; Bone surgery ; Care and treatment ; Cartilage diseases ; Classification ; Cohort analysis ; Complications ; Complications and side effects ; Cyclooxygenase-2 ; Data acquisition ; Data collection ; Databases, Factual ; Defensive behavior ; Degeneration ; Destruction ; Developing countries ; Diagnosis ; Disabilities ; Drugs ; Female ; Health care ; Health insurance ; Health risks ; Health services ; Hospitals ; Humans ; Incidence ; Inflammation ; Inhibition ; Injection ; Injuries ; Joint diseases ; Joint surgery ; Knee ; Knee replacement arthroplasty ; LDCs ; Male ; Manpower ; Medical research ; Medical science ; Medicine ; Medicine and Health Sciences ; Middle Aged ; Military ; Mobility ; National Health Programs ; Nursing ; Older people ; Osteoarthritis ; Osteoarthritis, Knee - complications ; Pain ; Patient outcomes ; Physiological aspects ; Population studies ; Prostaglandin endoperoxide synthase ; Retrospective Studies ; Risk factors ; Rupture ; Rural areas ; Skin & tissue grafts ; Studies ; Surgical implants ; Taiwan</subject><ispartof>PloS one, 2017-05, Vol.12 (5), p.e0178292-e0178292</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Lin et al 2017 Lin et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-2ade81aa3b00947421f808fe0fa70984a9aa594c1ff74915eccc5420bb71ca0f3</citedby><cites>FETCH-LOGICAL-c692t-2ade81aa3b00947421f808fe0fa70984a9aa594c1ff74915eccc5420bb71ca0f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448760/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5448760/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2100,2926,23864,27922,27923,53789,53791,79370,79371</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28558029$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Nazarian, Ara</contributor><creatorcontrib>Lin, Sheng-Hsiung</creatorcontrib><creatorcontrib>Wang, Ting-Chuan</creatorcontrib><creatorcontrib>Lai, Chun-Fu</creatorcontrib><creatorcontrib>Tsai, Ru-Yin</creatorcontrib><creatorcontrib>Yang, Chih-Ping</creatorcontrib><creatorcontrib>Wong, Chih-Shung</creatorcontrib><title>Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>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.
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).
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.</description><subject>Adult</subject><subject>Age</subject><subject>Aging</subject><subject>Aging (artificial)</subject><subject>Amino acids</subject><subject>Analysis</subject><subject>Anesthesiology</subject><subject>Anterior cruciate ligament</subject><subject>Anterior Cruciate Ligament Injuries - complications</subject><subject>Anti-inflammatory agents</subject><subject>Armed forces</subject><subject>Arthritis</subject><subject>Arthroplasty (knee)</subject><subject>Arthroplasty, Replacement, Knee - adverse effects</subject><subject>Arthroscopy</subject><subject>Artificial joints</subject><subject>Attenuation</subject><subject>Biocompatibility</subject><subject>Biology and Life Sciences</subject><subject>Body mass</subject><subject>Body mass index</subject><subject>Bone surgery</subject><subject>Care and treatment</subject><subject>Cartilage diseases</subject><subject>Classification</subject><subject>Cohort analysis</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Cyclooxygenase-2</subject><subject>Data acquisition</subject><subject>Data collection</subject><subject>Databases, Factual</subject><subject>Defensive behavior</subject><subject>Degeneration</subject><subject>Destruction</subject><subject>Developing countries</subject><subject>Diagnosis</subject><subject>Disabilities</subject><subject>Drugs</subject><subject>Female</subject><subject>Health care</subject><subject>Health insurance</subject><subject>Health risks</subject><subject>Health services</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Incidence</subject><subject>Inflammation</subject><subject>Inhibition</subject><subject>Injection</subject><subject>Injuries</subject><subject>Joint diseases</subject><subject>Joint surgery</subject><subject>Knee</subject><subject>Knee replacement arthroplasty</subject><subject>LDCs</subject><subject>Male</subject><subject>Manpower</subject><subject>Medical research</subject><subject>Medical science</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Military</subject><subject>Mobility</subject><subject>National Health Programs</subject><subject>Nursing</subject><subject>Older people</subject><subject>Osteoarthritis</subject><subject>Osteoarthritis, Knee - complications</subject><subject>Pain</subject><subject>Patient outcomes</subject><subject>Physiological aspects</subject><subject>Population studies</subject><subject>Prostaglandin endoperoxide synthase</subject><subject>Retrospective Studies</subject><subject>Risk factors</subject><subject>Rupture</subject><subject>Rural areas</subject><subject>Skin & tissue grafts</subject><subject>Studies</subject><subject>Surgical implants</subject><subject>Taiwan</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk9tuEzEQhlcIREvgDRBYQkJwkWB7vQf3Aikqh0aqqASFW2vijBOHzTrY3pY8GO-HN0mrBvUCrbQH-_v_Gc_OZNlzRkcsr9i7pet8C81o7VocUVbVXPIH2TGTOR-WnOYP77wfZU9CWFJa5HVZPs6OeF0UNeXyOPszDsFpC9G6ljhDoI3orfNE-65fRtLYOaywjcS2y85vyLWNC_KzRSQuRHTg48LbaEOSzkh0EZrdrsd1Axp76QkZp8_oXVijjvYKiXYL5yMJsZttiPFuReICySXYa2jJl202yecMoUnBJm3oPLQayQeIMIWAT7NHBpqAz_bPQfb908fL07Ph-cXnyen4fKhLyeOQwwxrBpBPKZWiEpyZmtYGqYGKylqABCik0MyYSkhWoNa6EJxOpxXTQE0-yF7ufNeNC2pf8aCYpLlkJc9lIiY7YuZgqdbersBvlAOrtgvOz1WqkNUNKiZYxU3Bdc65kFzWVQG6nFailIga-2jv99G66QpnOlXOQ3NgerjT2oWauytVCFFXJU0Gb_YG3v3qMES1skFj00CLrtvmLVLSLN0G2at_0PtPt6fmkA5gW-NSXN2bqrGQeVEVvOjDju6h0jXDldWpPY1N6weCtweCxET8HefQhaAm377-P3vx45B9fYddbLsnuKbr2ykcgmIH6tSTwaO5LTKjqp-um2qofrrUfrqS7MXdH3Qruhmn_C9TMyOu</recordid><startdate>20170530</startdate><enddate>20170530</enddate><creator>Lin, Sheng-Hsiung</creator><creator>Wang, Ting-Chuan</creator><creator>Lai, Chun-Fu</creator><creator>Tsai, Ru-Yin</creator><creator>Yang, Chih-Ping</creator><creator>Wong, Chih-Shung</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20170530</creationdate><title>Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database</title><author>Lin, Sheng-Hsiung ; Wang, Ting-Chuan ; Lai, Chun-Fu ; Tsai, Ru-Yin ; Yang, Chih-Ping ; Wong, Chih-Shung</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-2ade81aa3b00947421f808fe0fa70984a9aa594c1ff74915eccc5420bb71ca0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Age</topic><topic>Aging</topic><topic>Aging (artificial)</topic><topic>Amino acids</topic><topic>Analysis</topic><topic>Anesthesiology</topic><topic>Anterior cruciate ligament</topic><topic>Anterior Cruciate Ligament Injuries - complications</topic><topic>Anti-inflammatory agents</topic><topic>Armed forces</topic><topic>Arthritis</topic><topic>Arthroplasty (knee)</topic><topic>Arthroplasty, Replacement, Knee - adverse effects</topic><topic>Arthroscopy</topic><topic>Artificial joints</topic><topic>Attenuation</topic><topic>Biocompatibility</topic><topic>Biology and Life Sciences</topic><topic>Body mass</topic><topic>Body mass index</topic><topic>Bone surgery</topic><topic>Care and treatment</topic><topic>Cartilage diseases</topic><topic>Classification</topic><topic>Cohort analysis</topic><topic>Complications</topic><topic>Complications and side effects</topic><topic>Cyclooxygenase-2</topic><topic>Data acquisition</topic><topic>Data collection</topic><topic>Databases, Factual</topic><topic>Defensive behavior</topic><topic>Degeneration</topic><topic>Destruction</topic><topic>Developing countries</topic><topic>Diagnosis</topic><topic>Disabilities</topic><topic>Drugs</topic><topic>Female</topic><topic>Health care</topic><topic>Health insurance</topic><topic>Health risks</topic><topic>Health services</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Incidence</topic><topic>Inflammation</topic><topic>Inhibition</topic><topic>Injection</topic><topic>Injuries</topic><topic>Joint diseases</topic><topic>Joint surgery</topic><topic>Knee</topic><topic>Knee replacement arthroplasty</topic><topic>LDCs</topic><topic>Male</topic><topic>Manpower</topic><topic>Medical research</topic><topic>Medical science</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Middle Aged</topic><topic>Military</topic><topic>Mobility</topic><topic>National Health Programs</topic><topic>Nursing</topic><topic>Older people</topic><topic>Osteoarthritis</topic><topic>Osteoarthritis, Knee - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lin, Sheng-Hsiung</au><au>Wang, Ting-Chuan</au><au>Lai, Chun-Fu</au><au>Tsai, Ru-Yin</au><au>Yang, Chih-Ping</au><au>Wong, Chih-Shung</au><au>Nazarian, Ara</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-05-30</date><risdate>2017</risdate><volume>12</volume><issue>5</issue><spage>e0178292</spage><epage>e0178292</epage><pages>e0178292-e0178292</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.
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).
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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28558029</pmid><doi>10.1371/journal.pone.0178292</doi><tpages>e0178292</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2017-05, Vol.12 (5), p.e0178292-e0178292 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_1903916239 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adult Age Aging Aging (artificial) Amino acids Analysis Anesthesiology Anterior cruciate ligament Anterior Cruciate Ligament Injuries - complications Anti-inflammatory agents Armed forces Arthritis Arthroplasty (knee) Arthroplasty, Replacement, Knee - adverse effects Arthroscopy Artificial joints Attenuation Biocompatibility Biology and Life Sciences Body mass Body mass index Bone surgery Care and treatment Cartilage diseases Classification Cohort analysis Complications Complications and side effects Cyclooxygenase-2 Data acquisition Data collection Databases, Factual Defensive behavior Degeneration Destruction Developing countries Diagnosis Disabilities Drugs Female Health care Health insurance Health risks Health services Hospitals Humans Incidence Inflammation Inhibition Injection Injuries Joint diseases Joint surgery Knee Knee replacement arthroplasty LDCs Male Manpower Medical research Medical science Medicine Medicine and Health Sciences Middle Aged Military Mobility National Health Programs Nursing Older people Osteoarthritis Osteoarthritis, Knee - complications Pain Patient outcomes Physiological aspects Population studies Prostaglandin endoperoxide synthase Retrospective Studies Risk factors Rupture Rural areas Skin & tissue grafts Studies Surgical implants Taiwan |
| title | Association of anterior cruciate ligament injury with knee osteoarthritis and total knee replacement: A retrospective cohort study from the Taiwan National Health Insurance Database |
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