Health-related Outcomes following a Youth Sport–related Knee Injury

Purpose Active youth are vulnerable to knee injury and subsequent osteoarthritis. Improved understanding of the association between health-related outcomes and history of joint injury could inform osteoarthritis prevention strategies. The purpose of this historical cohort study is to examine the association between youth sport-related knee injury and various clinical, physiological, behavioral and functional health-related outcomes, 3-10 years post-injury. Methods Participants included 100 individuals who experienced a youth sport-related knee injury 3-10 years earlier and 100 age, sex and sport-matched uninjured controls. Outcomes include; Knee injury and Osteoarthritis Outcome Score (KOOS), Intermittent and Constant Osteoarthritis Pain Score, body mass index (BMI), fat mass index (FMI), weekly physical activity, estimated aerobic capacity, hip and knee muscle strength, and dynamic balance. Baseline characteristics were described. Multivariable regression models (95%CI) were used to evaluate the association between injury history and each outcome, considering the influence of sex and time-since-injury. Results Participant median age was 22 years (range 15-26) and 55% were female. The injured group demonstrated poorer KOOS sub-scale scores, more total and intermittent pain, higher BMI (1.8kg/m2; 95%CI 0.9,2.6), higher FMI (1.1kg/m2; 95%CI 0.5,1.6), weaker knee extensor (-0.18 NM/kg; 95%CI -0.33,-0.02) and flexor (-0.21 Nm/kg; 95%CI -0.30,-0.11) muscles, and poorer balance than controls. In the previously injured group, female sex was associated with poorer KOOS quality-of-life scores, knee flexor strength and greater FMI, while longer time-since-injury was associated with poorer KOOS symptoms scores, knee extensor strength and balance outcomes. Conclusion Youth that suffer a sport-related knee injury demonstrate on average more negative health-related outcomes consistent with future osteoarthritis compared to uninjured matched controls 3-10 years following injury. These negative outcomes differ by sex and time-since-injury. Corresponding Author: Dr. Jackie Whittaker, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, 8205-114 Street, Edmonton, AB, Canada, T6G 2G4. Tel: 1-780-492-5970 Fax: 1-780-492-4429 E-mail: jwhittak@ualberta.ca The Alberta PrE-OA cohort is funded by the Canadian Institutes of Health Research (MOP 133597), the Alberta Team Osteoarthritis Team supported by Alberta Innovates and the Alberta Children's Hospital Research Institute Chair in Pediatric Rehabilitation (Alberta Children's Hospital Foundation). CONFLICT OF INTEREST: JW and CT were awarded AIHS Clinician Fellowships to support this cohort study. LJW has a consultation arrangement with Eli Lilly Inc. CAE holds a Chair in Pediatric Rehabilitation funded by the Alberta Children's Hospital Foundation. All other authors certify that they have no affiliations with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the article. The sponsors had no involvement with respect to design, collection or data, analyses, interpretation writing or submission. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation and do not constitute endorsement by the ACSM. Accepted for Publication: 12 September 2018. © 2018 American College of Sports Medicine

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