The Risk of Knee Arthroplasty Following Cruciate Ligament Reconstruction
Bibliographic record
Abstract
BACKGROUND: Evidence regarding the risk of end-stage osteoarthritis following cruciate ligament reconstruction is based upon small sample sizes and radiographic, rather than clinical, criteria. The goals of this study were to determine the risk of knee arthroplasty, a surrogate for end-stage osteoarthritis, following cruciate ligament reconstruction, and to identify patient, provider, and surgical factors that influence knee arthroplasty risk. METHODS: Using administrative databases, we identified all patients who were sixteen to sixty years of age and had undergone cruciate ligament reconstruction in Ontario from July 1993 to March 2008. Case patients were matched by demographic variables to five individuals without knee injury from the general population of Ontario, Canada, who had not undergone previous knee surgery, including cruciate ligament reconstruction. The main outcome was knee arthroplasty. Kaplan-Meier survival curves were generated for both cohorts. A Cox proportional hazards model determined those factors that influenced knee arthroplasty risk. RESULTS: We identified 30,301 eligible patients who had undergone cruciate ligament reconstruction; of these patients, 30,277 were matched to 151,362 individuals from the general population; the median patient age was twenty-eight years and 65% of the patients were male. Primary anterior cruciate ligament reconstruction accounted for >98% of index cases. During the follow-up period, there was a significant difference (p < 0.001) between matched case and control cohorts with respect to the number of patients who underwent knee arthroplasty during the study period; in the matched case cohort, 209 patients underwent knee arthroplasty (event rate, 0.68 of 1000 person-years), and in the control cohort, 125 patients underwent knee arthroplasty (event rate, 0.10 of 1000 person-years). Moreover, fifteen years after cruciate ligament reconstruction (case cohort) or study enrollment (control cohort), there was a significant difference (p < 0.001) in the cumulative incidence of knee arthroplasty between the case cohort (1.4%) and the control cohort (0.2%). Age of fifty years or more (hazard ratio, 37.28; p < 0.001), female sex (hazard ratio, 1.58; p = 0.001), comorbidity score of ≥5 points (hazard ratio, 5.91; p = 0.002), surgeon annual volume of cruciate ligament reconstruction of twelve or fewer cases per year (hazard ratio, 2.53; p < 0.001), and cruciate ligament reconstruction undertaken in university-affiliated hospitals (hazard ratio, 1.51, p = 0.008) increased the odds of knee arthroplasty; however, male sex (hazard ratio, 0.63; p = 0.001) and patient age of less than twenty years (hazard ratio, 0.07; p = 0.009) were protective. Concurrent meniscal repair or debridement did not increase arthroscopy risk. CONCLUSIONS: After fifteen years, the cumulative incidence of knee arthroplasty following cruciate ligament reconstruction was low (1.4%); however, it was seven times greater than the cumulative incidence of knee arthroplasty among matched control patients from the general population (0.2%). Older age, female sex, higher comorbidity, low surgeon annual volume of cruciate ligament reconstruction, and cruciate ligament reconstruction performed in a university-affiliated hospital were factors that increased knee arthroplasty risk.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".