{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T10:48:38Z","timestamp":1782989318349,"version":"3.54.5"},"reference-count":23,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Knee injuries are established risk factors for knee osteoarthritis (OA). We aimed to investigate whether surgically treated knee injuries are associated with an increased incidence of end\u2011stage knee OA necessitating knee arthroplasty (KA).Methods:\u00a0Using nationwide Finnish registers, we identified all individuals aged 15\u201399 years who underwent surgery for knee injuries between 1986 and 2024. Injuries were categorized as knee fracture surgeries or non\u2011fracture knee injury surgeries. The date of the first identified injury surgery served as the index point from which person years under the exposure of interest were accrued. The control population comprised all Finnish residents without a recorded knee injury diagnosis and surgical treatment. Diagnoses and procedures were retrieved from the Care Register for Health Care (CRHC); KAs were identified from the Finnish Arthroplasty Register (FAR) and CRHC. Incidence rates of KA were calculated for both injury categories and the control population, stratified by age, sex, and year. Incidence comparisons between exposure and control groups were performed using age\u2011, sex\u2011, and year-standardized standardized incidence ratios (SIRs).Results:\u00a0In the fracture surgery cohort, there were 2,163 KAs with over 489,000 person\u2011years of follow\u2011up. In the non\u2011fracture injury surgery cohort there were 13,570 KAs with over 3.01 million person\u2011years of follow\u2011up. In the control population there were 205,440 KAs with over 167 million person\u2011years of follow\u2011up. Relative to the corresponding general population, the incidence of KA was increased in both injury categories, non-fracture injury surgery SIR 3.74 (95% confidence interval [CI] 3.68\u20133.80) and fracture surgery SIR 2.08 (CI 1.99\u20132.17). The greatest excess was among the youngest group (15\u201354 years): fracture surgery SIR 8.12 (CI 7.40\u20138.89); non\u2011fracture injury surgery SIR 6.05 (CI 5.84\u20136.27).Conclusion:\u00a0Surgically treated knee injuries were associated with an increased incidence of KA, most notably in those aged 15\u201354 years. In older age groups, the additional effect of the injury surgery appears smaller, likely because age itself markedly increases the baseline incidence of KA.<\/jats:p>","DOI":"10.2340\/17453674.2026.46170","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T09:43:07Z","timestamp":1782985387000},"source":"Crossref","is-referenced-by-count":0,"title":["Association between surgically treated knee injury and knee arthroplasty: an explorative study based on Finnish nationwide register-based data"],"prefix":"10.2340","volume":"97","author":[{"given":"Olli","family":"Heikkil\u00e4","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6268-8117","authenticated-orcid":false,"given":"Reijo","family":"Sund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heikki","family":"Kr\u00f6ger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antti","family":"Jaroma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joonas","family":"Sirola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"161245","unstructured":"Hsu H, Siwiec R M. Knee osteoarthritis. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2025 [accessed 12. September 2025]. Available from: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK507884\/"},{"key":"161246","doi-asserted-by":"crossref","unstructured":"Long H, Liu Q, Yin H, Wang K, Diao N, Zhang Y, et al. Prevalence trends of site-specific osteoarthritis from 1990 to 2019: findings from the global burden of disease study 2019. Arthritis Rheum 2022; 74(7): 1172-83. doi: 10.1002\/art.42089.","DOI":"10.1002\/art.42089"},{"key":"161247","doi-asserted-by":"crossref","unstructured":"Cooper C, Snow S, McAlindon T E, Kellingray S, Stuart B, Coggon D, et al. Risk factors for the incidence and progression of radiographic knee osteoarthritis. Arthritis Rheum 2000; 43(5): 995\u20131000. doi: 10.1002\/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1.","DOI":"10.1002\/1529-0131(200005)43:5<995::AID-ANR6>3.0.CO;2-1"},{"key":"161248","doi-asserted-by":"crossref","unstructured":"Blagojevic M, Jinks C, Jeffery A, Jordan K P. Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta\u2011analysis. Osteoarthritis Cartilage 2010; 18(1): 24-33. doi: 10.1016\/j.joca.2009.08.010.","DOI":"10.1016\/j.joca.2009.08.010"},{"key":"161249","doi-asserted-by":"crossref","unstructured":"Whittaker J L, Losciale J M, Juhl C B, Thorlund J B, Lundberg M, Truong L K, et al. Risk factors for knee osteoarthritis after traumatic knee injury: a systematic review and meta\u2011analysis of randomised controlled trials and cohort studies for the OPTIKNEE Consensus. Br J Sports Med 2022; 56(24): 1406-21. doi: 10.1136\/bjsports-2022-105496.","DOI":"10.1136\/bjsports-2022-105496"},{"key":"161250","doi-asserted-by":"crossref","unstructured":"Poulsen E, Goncalves G H, Bricca A, Roos E M, Thorlund J B, Juhl C B. Knee osteoarthritis risk is increased 4\u20116 fold after knee injury: a systematic review and meta\u2011analysis. Br J Sports Med 2019; 53(23): 1454-63. doi: 10.1136\/bjsports-2018-100022.","DOI":"10.1136\/bjsports-2018-100022"},{"key":"161251","doi-asserted-by":"crossref","unstructured":"Snoeker B, Turkiewicz A, Magnusson K, Frobell R, Yu D, Peat G, et al. Risk of knee osteoarthritis after different types of knee injuries in young adults: a population\u2011based cohort study. Br J Sports Med 2020; 54(12): 725-30. doi: 10.1136\/bjsports-2019-100959.","DOI":"10.1136\/bjsports-2019-100959"},{"key":"161252","doi-asserted-by":"crossref","unstructured":"Jordan K M, Arden N K, Doherty M, Bannwarth B, Bijlsma J W J, Dieppe P, et al. EULAR Recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62(12): 1145-55. doi: 10.1136\/ard.2003.011742.","DOI":"10.1136\/ard.2003.011742"},{"key":"161253","doi-asserted-by":"crossref","unstructured":"Skou S T, Roos E M, Laursen M B, Rathleff M S, Arendt\u2011Nielsen L, Simonsen O H, et al. Total knee replacement plus physical and medical therapy or treatment with physical and medical therapy alone: a randomised controlled trial in patients with knee osteoarthritis (the MEDIC\u2011study). BMC Musculoskelet Disord 2012; 13: 67. doi: 10.1186\/1471-2474-13-67.","DOI":"10.1186\/1471-2474-13-67"},{"key":"161254","doi-asserted-by":"crossref","unstructured":"Visnes H, Gifstad T, Persson A, Lygre S H L, Engebretsen L, Drogset J O, et al. ACL reconstruction patients have increased risk of knee arthroplasty at 15 years of follow\u2011up: data from the Norwegian Knee Ligament Register and the Norwegian Arthroplasty Register from 2004 to 2020. JB JS Open Access 2022; 7(2): e22.00023. doi: 10.2106\/JBJS.OA.22.00023.","DOI":"10.2106\/JBJS.OA.22.00023"},{"key":"161255","doi-asserted-by":"crossref","unstructured":"Abram S G F, Judge A, Khan T, Beard D J, Price A J. Rates of knee arthroplasty in anterior cruciate ligament reconstructed patients: a longitudinal cohort study of 111,212 procedures over 20 years. Acta Orthop 2019; 90(6): 568-74. doi: 10.1080\/17453674.2019.1639360.","DOI":"10.1080\/17453674.2019.1639360"},{"key":"161256","doi-asserted-by":"crossref","unstructured":"Tapper V S, Pamilo K J, Haapakoski J J, Toom A, Paloneva J. Risk of total knee replacement after proximal tibia fracture: a register\u2011based study of 7,701 patients. Acta Orthop 2022; 93: 179-84. doi: 10.2340\/17453674.2021.1006.","DOI":"10.2340\/17453674.2021.1006"},{"key":"161257","doi-asserted-by":"crossref","unstructured":"Abram S G F, Judge A, Beard D J, Carr A J, Price A J. Long\u2011term rates of knee arthroplasty in a cohort of 834 393 patients with a history of arthroscopic partial meniscectomy. Bone Joint J 2019; 101\u2011B (9): 1071-80. doi: 10.1302\/0301-620X.101B9.BJJ-2019-0335.R1.","DOI":"10.1302\/0301-620X.101B9.BJJ-2019-0335.R1"},{"key":"161258","doi-asserted-by":"crossref","unstructured":"Muthuri S G, McWilliams D F, Doherty M, Zhang W. History of knee injuries and knee osteoarthritis: a meta\u2011analysis of observational studies. Osteoarthritis Cartilage 2011; 19(11): 1286-93. doi: 10.1016\/j.joca.2011.07.015.","DOI":"10.1016\/j.joca.2011.07.015"},{"key":"161259","unstructured":"PxWeb. Population 31.12. by Year, Sex, Age and Information [Internet] [accessed December 17, 2025]. 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Cross\u2011validation of arthroplasty records between arthroplasty and hospital discharge registers, self\u2011reports, and medical records among a cohort of 14,220 women. J Arthroplasty 2018; 33(12): 3649-54. doi: 10.1016\/j.arth.2018.08.010.","DOI":"10.1016\/j.arth.2018.08.010"},{"key":"161263","doi-asserted-by":"crossref","unstructured":"Medvedeva E V, Grebenik E A, Gornostaeva S N, Telpuhov V I, Lychagin A V, Timashev P S, et al. Repair of damaged articular cartilage: current approaches and future directions. Int J Mol Sci 2018; 19(8): 2366. doi: 10.3390\/ijms19082366.","DOI":"10.3390\/ijms19082366"},{"key":"161264","doi-asserted-by":"crossref","unstructured":"Deichsel A, Oeckenp\u00f6hler S, Raschke M J, Grunenberg O, Peez C, Briese T, et al. Recurrent instability rate and subjective knee function following accelerated rehabilitation after ACL reconstruction in comparison to a conservative rehabilitation protocol. 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Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time\u2011series analysis using nationwide Danish healthcare registers. 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