Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Nov 1;7(4):100700.
doi: 10.1016/j.ocarto.2025.100700. eCollection 2025 Dec.

Long-term impact of acute knee injury with hemarthrosis: Osteoarthritis incidence and patient-reported outcomes in a large consecutive cohort over 12 years

Anders Isacsson  1   2 , Aleksandra Turkiewicz  1 , Ola Olsson  2 , Jamie S Brown  1   3 , Johan Hesslow  2   4 , Patrik Bengtsson  2   4 , Armaghan Mahmoudian  1   5 , Richard B Frobell  4 , Jaanika Paemre  6 , Martin Englund  1
Affiliations

Long-term impact of acute knee injury with hemarthrosis: Osteoarthritis incidence and patient-reported outcomes in a large consecutive cohort over 12 years

Anders Isacsson et al. Osteoarthr Cartil Open. .

Abstract

Objective: To estimate the 12-year risk of radiographic and/or symptomatic knee osteoarthritis following different MRI-confirmed soft-tissue knee injuries.

Design: Prospective cohort study including 814 (70 ​%) of 1129 consecutive patients after acute knee trauma with hemarthrosis in a single hospital. Injuries were classified by sub-acute knee MRI. Follow-up comprised bilateral knee radiography and Knee injury and Osteoarthritis Outcome Score. The main outcomes were radiographic and symptomatic knee osteoarthritis. We estimated differences between injury types and injured versus contralateral knees.

Results: The incidence proportion of radiographic knee osteoarthritis was 34 ​% (95 ​% confidence interval 30 to 37) in injured knees and 18 ​% (15, 20) in contralateral knees. Knees with hemarthrosis but no structural injury developed radiographic osteoarthritis and symptomatic osteoarthritis in 6 ​% and 4 ​%, respectively, as compared to 36 ​% and 21 ​% of those with structural injury, with risk ratios (95 ​% confidence interval) of 8 (3, 21) for radiographic osteoarthritis and 6 (2, 20) for symptomatic osteoarthritis. The risk ratio of tibiofemoral osteoarthritis in the injured knee compared to the contralateral knee was 2.2 (1.7, 2.8), with the highest ratio of 3.1 (2.1, 4.6) observed after combined anterior cruciate ligament (ACL) and meniscus injury. Overall, 81 ​% (78, 84) reported satisfaction with their knee function, though satisfaction was lower following patellar dislocation.

Conclusions: Structural soft-tissue knee injury doubled the risk of radiographic and symptomatic knee osteoarthritis versus the contralateral knee over 12 years with significant variation based on injury type. ACL rupture combined with meniscus tear conferred the highest risk while hemarthrosis alone the lowest.

Keywords: Anterior cruciate ligament; Hemarthrosis; Knee; Osteoarthritis; Outcome; Soft-tissue knee injury.

PubMed Disclaimer

Conflict of interest statement

ME reports consultancy for Grünenthal Sweden AB, Key2 Compliance AB, and Genascence. AT is associate editor for statistics at the Osteoarthritis and Cartilage journal. All other authors report no conflicts of interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study cohort and loss to follow-up by reason. PROMs, patient-reported outcome measures.
Fig. 2
Fig. 2
Incidence proportions of radiographic knee osteoarthritis (OA) and symptomatic knee OA by injury group with 95 ​% CIs and comparisons between index and contralateral knees. Radiographic OA, OA in any compartment. Symptomatic OA, radiographic OA in combination with KOOS scores equivalent with a knee considered symptomatic. KOOS, Knee injury and Osteoarthritis Outcome Score. PF, patellofemoral. TF, tibiofemoral. Please see Table 1 for description of injury types and other abbreviations, Table 3 for count values per subgroup, and suppl Fig. 2 for definition of a symptomatic knee.
Fig. 3
Fig. 3
KOOS subscales by injury type. Box plot with medians and interquartile range shown as boxes. KOOS, Knee injury and Osteoarthritis Outcome Score. ADL, activities of daily living. QOL, quality of life. Please see Table 1 for description of injury types and other abbreviations.
See this image and copyright information in PMC

References

    1. 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-based cohort study. Br. J. Sports Med. 2020;54:725–730. - PubMed
    1. Maffulli N., Longo U.G., Gougoulias N., Loppini M., Denaro V. Long-term health outcomes of youth sports injuries. Br. J. Sports Med. 2010;44:21–25. - PubMed
    1. Gelber A.C., Hochberg M.C., Mead L.A., Wang N.Y., Wigley F.M., Klag M.J. Joint injury in young adults and risk for subsequent knee and hip osteoarthritis. Ann. Intern. Med. 2000;133:321–328. - PubMed
    1. Spindler K.P., Warren T.A., Callison J.C., Jr., Secic M., Fleisch S.B., Wright R.W. Clinical outcome at a minimum of five years after reconstruction of the anterior cruciate ligament. J Bone Joint Surg Am. 2005;87:1673–1679. - PubMed
    1. Lohmander L.S., Englund P.M., Dahl L.L., Roos E.M. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am. J. Sports Med. 2007;35:1756–1769. - PubMed

LinkOut - more resources