{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T10:31:54Z","timestamp":1794047514473,"version":"4.8.0"},"reference-count":85,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2013,11,8]],"date-time":"2013-11-08T00:00:00Z","timestamp":1383868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. However, there has been no meta-analysis reporting the development and progression of osteoarthritis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>We present the first meta-analysis reporting on the development and progression of osteoarthritis after ACL injury at a minimum mean follow-up of 10 years, using a single and widely accepted radiologic classification, the Kellgren &amp; Lawrence classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>Articles were included for systematic review if they reported radiologic findings of ACL-injured knees and controls using the Kellgren &amp; Lawrence classification at a minimum mean follow-up period of 10 years. Appropriate studies were then included for meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Nine studies were included for systematic review, of which 6 studies were further included for meta-analysis. One hundred twenty-one of 596 (20.3%) ACL-injured knees had moderate or severe radiologic changes (Kellgren &amp; Lawrence grade III or IV) compared with 23 of 465 (4.9%) uninjured ACL-intact contralateral knees. After ACL injury, irrespective of whether the patients were treated operatively or nonoperatively, the relative risk (RR) of developing even minimal osteoarthritis was 3.89 ( P &lt; .00001), while the RR of developing moderate to severe osteoarthritis (grade III and IV) was 3.84 ( P &lt; .0004). Nonoperatively treated ACL-injured knees had significantly higher RR (RR, 4.98; P &lt; .00001) of developing any grade of osteoarthritis compared with those treated with reconstructive surgery (RR, 3.62; P &lt; .00001). Investigation of progression to moderate or severe osteoarthritis (grade III or IV only) after 10 years showed that ACL-reconstructed knees had a significantly higher RR (RR, 4.71; P &lt; .00001) compared with nonoperative management (RR, 2.41; P = .54). It was not possible to stratify for return to sports among the patients undergoing ACL reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Results support the proposition that ACL injury predisposes knees to osteoarthritis, while ACL reconstruction surgery has a role in reducing the risk of developing degenerative changes at 10 years. However, returning to sports activities after ligament reconstruction may exacerbate the development of arthritis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0363546513508376","type":"journal-article","created":{"date-parts":[[2013,11,9]],"date-time":"2013-11-09T02:19:05Z","timestamp":1383963545000},"page":"2242-2252","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":423,"title":["Anterior Cruciate Ligament Injury and Radiologic Progression of Knee Osteoarthritis"],"prefix":"10.1177","volume":"42","author":[{"given":"Adil","family":"Ajuied","sequence":"first","affiliation":[{"name":"Department of Trauma & Orthopaedic, Guy\u2019s & St Thomas\u2019 NHS Foundation Trust, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Trauma & Orthopaedic, Guy\u2019s & St Thomas\u2019 NHS 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