Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: A knee injury increases the risk for early-onset osteoarthritis (OA) and accelerated knee OA progression but little is known about risk factors for injuries among adults. Knee pain and a history of knee injury may be key risk factors because both can lead to altered joint biomechanics. Therefore, we explored if knee pain or a history of knee injury was associated with a knee injury in the subsequent 12 months.
Methods: We conducted longitudinal knee-based analyses among participants in the Osteoarthritis Initiative, a longitudinal observational study. We included both knees of all participants who attended baseline and had at least one follow-up visit with complete data. Our first set of exposures were knee pain (frequency and severity) at baseline, 12-month, 24-month, and 36-month visits. We defined frequent knee pain as pain on most days of a month in past 12 months. Knee pain severity was based on the WOMAC pain subscale, which we dichotomized as no-to-little pain (0 to 2) or knee pain (≥ 3). Another exposure was a history of injury, which we defined as a self-reported injury at any time prior to baseline, 12-month, 24-month, or 36-month visits. The outcome was self-reported knee injury during the past year at 12-month, 24-month, 36-month, and 48-month OAI visits. We conducted secondary analyses based on the bilateral absence or presence of knee OA at baseline, which we defined as Kellgren-Lawrence Grade ≥ 2. We evaluated the association between knee pain or history of injury (in both knees) and a new knee injury within 12 months of the exposure by performing repeated measures random intercept models to adjust for correlations within person observations over time and between knees. Analyses were adjusted for sex, age and body mass index at each visit.
Results: The baseline characteristics of the samples are presented in Table 1. In our primary analyses, individuals who reported frequent knee pain or an injury in either knee were more likely to experience a new knee injury in the following 12 months (Table 2) than individuals without frequent knee pain or prior injury. These findings were supported when we evaluated knee pain severity and in our secondary analyses. The only exception was that a history of a contralateral knee injury was not related with a new knee injury among those without radiographic OA at baseline.
Conclusion: Knee pain and a history of injury are associated with new knee injuries in the following 12 months. This may identify a group of people at higher risk for accelerated knee OA. It may be beneficial for individuals with knee pain or a history of injury to participate in injury prevention programs.
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Table 1. Descriptive Baseline Characteristics of the Study Samples in Primary and Secondary Analyses |
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Full OAI Cohort (n = 4,435) |
ROA at Baseline (n = 1,443) |
No ROA at Baseline (n = 1,863) |
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Age (years, mean (sd)) |
61.2 (9.2) |
63.0 (8.8) |
59.2 (9.0) |
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Body mass index (kg/m2, mean (sd)) |
28.6 (4.8) |
30.2 (5.0) |
27.2 (4.5) |
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Females (n (%)) |
2591 (58.4%) |
905 (62.7%) |
1095 (58.8%) |
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Frequent right knee pain (n (%)) |
1639 (37.0%) |
683 (47.3%) |
543 (29.2%) |
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WOMAC right knee pain score > 2 (n (%)) |
1567 (35.3%) |
687 (47.6%) |
498 (26.7%) |
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Frequent left knee pain (n (%)) |
1582 (35.7%) |
658 (45.6%) |
537 (28.9%) |
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WOMAC left knee pain score > 2 (n (%)) |
1349 (30.4%) |
609 (42.2%) |
412 (22.1%) |
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Note. ROA = radiographic osteoarthritis |
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Table 2. Frequent Knee Pain and History of Injury Predict a New Knee Injury within 12 Months |
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Frequency of Injuries/ Total Observations |
Adjusted Odds Ratio for Injury |
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Full Osteoarthritis Initiative (4,435 participants, 875 injuries) |
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No Frequent Knee Pain |
422/21312 (2.0%) |
Reference |
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Frequent Knee Pain |
453/10118 (4.5%) |
1.84 (1.57, 2.16) |
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No Frequent Contralateral Knee Pain |
502/21311 (2.4%) |
Reference |
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Frequent Contralateral Knee Pain |
373/10119 (3.7%) |
1.02 (0.87, 1.20) |
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No History of Knee Injury |
443/22275 (2.0%) |
Reference |
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History of Knee Injury |
432/9155 (4.7%) |
1.81 (1.56, 2.09) |
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No History of Contralateral Knee Injury |
518/22275 (2.3%) |
Reference |
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History of Contralateral Knee Injury |
357/9155 (3.9%) |
1.43 (1.23, 1.66) |
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Bilateral ROA at Baseline (1,443 participants, 345 injuries) |
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No Frequent Knee Pain |
128/5480 (2.3%) |
Reference |
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Frequent Knee Pain |
217/4265 (5.1%) |
1.76 (1.36, 2.28) |
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No Frequent Contralateral Knee Pain |
153/5479 (2.8%) |
Reference |
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Frequent Contralateral Knee Pain |
192/4266 (4.5%) |
1.08 (0.84, 1.39) |
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No History of Knee Injury |
156/6365 (2.5%) |
Reference |
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History of Knee Injury |
189/3380 (5.6%) |
1.69 (1.33, 2.15) |
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No History of Contralateral Knee Injury |
172/6365 (2.7%) |
Reference |
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History of Contralateral Knee Injury |
173/3380 (5.1%) |
1.65 (1.30, 2.10) |
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No ROA at Baseline (1,863 participants, 280 injuries) |
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No Frequent Knee Pain |
173/10215 (1.7%) |
Reference |
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Frequent Knee Pain |
107/3257 (3.3%) |
1.75 (1.30, 2.34) |
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No Frequent Contralateral Knee Pain |
199/10216 (2.0%) |
Reference |
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Frequent Contralateral Knee Pain |
81/3256 (2.5%) |
0.90 (0.66, 1.23) |
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No History of Knee Injury |
166/10298 (1.6%) |
Reference |
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History of Knee Injury |
114/3174 (3.6%) |
1.82 (1.39, 2.38) |
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No History of Contralateral Knee Injury |
201/10299 (2.0%) |
Reference |
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History of Contralateral Knee Injury |
79/3173 (2.5%) |
1.08 (0.81, 1.44) |
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Note: In addition to the variables indicated above each model was adjusted for sex, age, and body mass index at each visit. Bold = significant odds ratios. |
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Disclosure:
J. B. Driban,
None;
G. H. Lo,
None;
L. L. Price,
None;
C. Eaton,
None;
B. Lu,
None;
T. E. McAlindon,
None.
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