| Abstract ID |
| 20260021 |
| Category |
| Sports Medicine: Epidemiology and Injury Prevention |
| Preferable Presentation |
| Poster |
| Title |
| POSTTRAUMATIC OSTEOARTHRITIS PREVALENCE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: AN UPDATED ANALYSIS OF 8,247 PATIENTS |
| Author |
|
| Presenter |
| Mingde Cao |
| Abstract |
| Background: Post-traumatic osteoarthritis (PTOA) following anterior cruciate ligament reconstruction (ACLR) represents a long-term clinical and socioeconomic burden, particularly given the young and active population affected. Although prior meta-analyses have demonstrated an increasing prevalence of PTOA with longer postoperative follow-up, incorporating updated and comprehensive literature is needed. Purpose/Hypothesis: The purpose of this study was to evaluate the incidence of radiographic PTOA following ACLR using an updated meta-regression analysis, with particular emphasis on the effect of postoperative follow-up duration. It was hypothesised that PTOA incidence increases over time following ACL reconstruction. Study Design: Systematic review and meta-analysis with meta-regression. Methods: A systematic review identified 67 studies comprising 8,247 patients who underwent ACLR with a minimum follow-up of 5 years. Radiographic PTOA was defined using established classification systems, including Kellgren–Lawrence, Ahlbäck, International Knee Documentation Committee, and Osteoarthritis Research Society International criteria. A random-effects meta-regression model using restricted maximum likelihood estimation (REML) with a quadratic time component was applied to assess the association between PTOA incidence and postoperative follow-up duration. Subgroup analyses were performed based on the study publication period. Results: Meta-regression demonstrated a significant positive association between increasing postoperative follow-up time and PTOA incidence, with evidence of nonlinear progression. The model-estimated incidence of PTOA (95% CI) was 19.7% (15.7%–24.4%) at 5 years, 26.3% (20.4%–33.1%) at 10 years, 33.7% (25.7%–42.7%) at 15 years, and 41.6% (25.1%–60.3%) at 20 years following ACL reconstruction. Studies published between 2019 and 2025 demonstrated a trend toward lower reported PTOA incidence compared with studies published between 2001 and 2018, suggesting potential improvements in surgical techniques, rehabilitation protocols, and perioperative management over time. Conclusion: The incidence of PTOA following ACL reconstruction increases progressively with longer postoperative follow-up, with more than 40% of patients demonstrating radiographic osteoarthritis by 20 years after surgery. Although more recent studies suggest a decline in reported PTOA incidence, ACL reconstruction does not eliminate the long-term risk of degenerative joint disease. These findings highlighted the ongoing need for targeted strategies aimed at PTOA prevention and long-term joint preservation following ACL injury. Keywords: anterior cruciate ligament; ACL reconstruction; posttraumatic osteoarthritis; meta-analysis; long-term outcomes |