Does Early Joint Trauma Lead to Osteoarthritis?

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

The complex structure of synovial joints is comprised of periarticular and subchondral bone, articular cartilage, synovial membrane, joint capsule, and periarticular musculature. It is within this complex that osteoarthritis develops. Previous research suggests that trauma or pathology compromising the integrity of one, or more of these synovial structures may contribute to the development of osteoarthritis. Few studies have specifically examined the association between injuries in young adults and their subsequent risk for this debilitating condition.

Gelber et al   [1] report on investigator–recorded prior and current injury status in a total of 1321 persons who graduated from the Johns Hopkins School of Medicine in Baltimore, Maryland, between 1948 and 1964, with the average age of 22 years. Subsequent trauma and specific arthritis sites were assessed using annual self–administered questionnaires. Injury was defined as "a report of trauma to the knee or hip joint (ICD-9 codes 715.95 and 715.96), including internal derangement or fracture."

After an average follow–up period of 36 years, 141 subjects reported injuries (111 knee injuries alone, 16 hip injuries alone, and 14 injuries of both), with 96 of those subjects developing osteoarthritis. By 65 years of age, 13.9% of participants reporting a knee injury in youth or young adulthood had developed osteoarthritis in the knee, comparing with only 6% of those without any such injury. Overall, prior joint injury significantly increased the risk for later–life osteoarthritis at the specific injury site.

The authors conclude that adolescents and young adults with traumatic injury are at substantially increased risk for osteoarthritis in their later years, and these patients comprise a "high risk" group. The authors suggest joint–stabilizing braces and exercises to minimize further damage in these circumstances. They also urge "...use of proper sports equipment under safe conditions to prevent joint injuries and decrease their long–term sequelae".

Roos et al   [2] reported previously that surgical removal of a meniscus, following a knee injury, represents a significant increased risk factor for tibiofemoral osteoarthritis. With this risk of increasing arthritic outcome with surgery, perhaps a more conservative approach, like chiropractic adjusting of the injured joint-complex should be explored.

Biedebach, Brantingham, and Snyder write that "Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability" in their 2 part series. Part I   (http://www.chiroweb.com/archives/12/07/12.html ) reports the relationship between fixation and loss of normal range of motion (ROM), and ties it to the development of arthritic changes, as reported in the scientific literature.

Part II   (http://www.chiroweb.com/archives/12/09/11.html) reports the improvements in ROM and function following spinal manipulation, and suggests that additional research is needed to determine exactly what degree of hypomobility must develop to initiate the onset of degenerative joint disease. There are 86 citations (with some overlap) which support their contention that osteoarthritis can be halted and even reversed with spinal adjusting.

REFERENCES:

[1]   Allan C. Gelber, MD, MPH, PhD; Marc C. Hochberg, MD, MPH; Lucy A. Mead, ScM; Nae-Yuh Wang, MS, PhD; Fredrick M. Wigley, MD; and Michael J. Klag, MD, MPH
Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis
Annals of Internal Medicine 2000;   133 (5) Sept 5:   321–328

[2]   Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K, Lohmander LS
Knee Osteoarthritis After Meniscectomy:   Prevalence of Radiographic Changes After Twenty-one Years, Compared with Matched Controls
Arthritis Rheum 1998;   41 (4) Apr:   687–93

[3]   Ressel, O.J. Disc Regeneration: Reversibility is Possible in Spinal Osteoarthritis
ICA Internat Rev Chiro 1989;   March:   39–61

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Updated 1-15-2006