OA quickly progresses among young military officers with knee injuries

Nearly one in five military officers who have had a knee injury developed radiographic osteoarthritis before 30 years of age, according to data presented at the ACR/ARHP 2018 Annual Meeting.

Military populations experience high rates of disability related to post-traumatic osteo­arthritis (PTOA), which does not always originate from combat injury. But military researchers are also uniquely posi­tion­ed to explore therapeutic options to minimize the effect of PTOA. Lower Extremity Review

by Stephanie Viguers, Healio Rheumatology November 14, 2018

The findings demonstrate that OA progression can occur quickly among younger adults with serious knee injuries and “physically-demanding occupations,” according to Yvonne M. Golightly PT PhD, assistant professor in the Department of Epidemiology and adjunct assistant professor in the Division of Physical Therapy at the University of North Carolina (UNC) at Chapel Hill.

“OA is not limited to middle-aged and older adults,” Golightly, who is also a faculty member at Thurston Arthritis Research Center and Injury Prevention Research Center at UNC, told Healio. “Young, physically-active populations, such as military personnel, are at high risk for knee injuries, and injury is a major risk factor for OA.”

Traumatic knee injuries, such as those to the anterior cruciate ligament and menisci, are linked to early onset and progression of OA, according to Golightly and colleagues. However, little is known about the underlying pathobiologic processes. To learn more, the researchers conducted a study through a partnership with the United States military to examine the impact of knee ligament, meniscal injury, or both, on radiographic OA among military officers, who are at an increased risk for knee injuries and experience prolonged biomechanical loads on the knee joint. The analysis included participants who joined the US Air Force Academy, US Military Academy, or US Naval Academy between 2004 and 2009. The mean age of participants was 27.7 years. Nearly 40% were women.

The incidence of radiographic OA — defined as a Kellgren-Lawrence grade 2 or higher — was assessed in 115 officers who had a knee injury before, during or after their 4-year military career. Their outcomes were compared with a matched cohort of 114 officers without knee injuries. All participants underwent bilateral knee radiographs, which were taken at military treatment facilities and transferred to an experienced musculoskeletal radiologist reader for review.

The average time between knee injury and radiographic assessment was 8.8 years. Radiographic OA was significantly more common among officers with a history of knee injury (16.5% vs. 0%). These officers were also more likely to have osteophytes (40.9% vs. 7%) and joint space narrowing (22.6% vs. 0.9%), the researchers reported.

There was no significant correlation between OA prevalence and the timing of knee injury, suggesting “‘early progressors’ react quickly to the physical insults of knee trauma and surgery,” the researchers reported in the abstract. The difference in OA prevalence was similar among participants who had their first knee injury at high school age, collegiate age and post-college age (14% vs. 20% vs. 13%).

Moving forward, Golightly said the research team will examine biochemical markers of cartilage changes or inflammation in blood samples to determine whether these markers may help predict early-onset OA following a knee injury.

“If we can identify individuals who are likely to progress to OA after injury, we may be able to intervene to slow or stop this process,” she said.

Source Healio Rheumatology

Association of Knee Ligament and/or Meniscal Injury with Radiographic Knee Osteoarthritis in Military Officers, Golightly YM, Nocera M, Beutler AI, Renner JB, Guermazi A, Cantrell J, Padua DA, Cameron KL, Svoboda SJ, Jordan JM, Loeser R, Callahan LF, Kraus VB, Lohmander LS, Marshall SW. Abstract 1161. Presented at ACR/ARHP Annual Meeting, Oct. 20-24, 2018 Chicago. Arthritis Rheumatol. 2018; 70 (suppl 10). Accessed November 15, 2018

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