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Anterior Cruciate Ligament Injury: A Risk Factor for Osteoarthritis

Studies now show that osteoarthritis can occur at a very young age when combined with an ACL injury.

Injury to the Anterior Cruciate Ligament (ACL) of the knee is the most common type of orthopedic trauma that occurs in young athletes. Can damage to the ACL be a risk factor for the development of osteoarthritis (OA) later in life? The answer is yes. In fact, research demonstrates that over fifty percent of those with a prior ACL injury can develop symptomatic osteoarthritis in as little as ten years after the incident occurred. Did you know that changes in the integrity of the cartilage can be seen as early as one to two years after an acute injury and women are four times as likely to tear their ACL tear when compared to men?

In a study from the Journal of Bone and Joint Surgery, the authors followed sixty one participants, of whom forty-five were male. The average age of the participants in the study was 25. All of them had documented prior injury to their ACL. Magnetic Resonance Imaging (MRI) was obtained of the damaged knee at three, six, twelve, and twenty-four months following the injury.

Changes in the integrity of the cartilage were observed over the two year span. Specifically, researchers demonstrated that there was bone thinning in the femur bone and new bone lesions appeared in twenty-one of the study participants. These new bone lesions may be a delayed reaction from this initial trauma. This study demonstrated that there is long-term damage to the bone and cartilage even if the person recovered from the acute injury. Risks factors for the bone thinning seen were older age and male gender.

Another study showed that for those individuals with prior ACL tears who develop OA, it is the lateral aspects of the femur and tibia that seem to be most affected. Other changes included a decrease in the bone surface area as well as damage to other ligaments (menisci) of the knee.

What can we do to reduce the risk? The first is to educate coaches, parents and athletes themselves of the potential long-term ramifications of an acute knee injury. If one occurs, rest needs to be allotted so the young athlete’s acute injury can properly heal. Avoiding overuse is easier said than done in our ultra-competitive environment.

Preventing these injuries from occurring in the first place is very important. Many young athletes either play one sport year round or are multi-sport athletes participating in athletics throughout the year. There needs to be time to allow the bones and joints to rest and recover. Many coaches and athletic trainers are changing their training focus to allow for rest days during the week.

Did you know that there are techniques that can be taught to athletes to prevent ACL injuries from occurring in the first place? Adding neuromuscular training to the athlete’s regimen can dramatically decrease the incidence of developing an acute ACL injury. These are training exercises that teach the young athlete how to use their legs properly. Focused prevention techniques such as neuromuscular training, proper nutrition, and allowing for periods of rest and recovery can reduce their risk of developing ACL injury and likely save them from developing symptomatic OA later in life. For more information on dynamic neuromuscular training to reduce the risk of developing ACL injuries, click on the following link:


  • Friel NA, Chu R. “The role of ACL injury in the development of posttraumatic knee osteoarthritis.” Clinics in Sport Medicine. 2013 Jan; 32(1):1-12.
  • Frobell RB. “Change in cartilage thickness, posttraumatic bone marrow lesions, and joint fluid volumes after acute ACL disruption: a two-year prospective MRI study of sixty-one subjects.” Journal of Bone and Joint Surgery. 2011 Jun 15;93(12):1096-103.
  • Myer GD, Ford KF “ Rationale and Clinical Techniques for Anterior Cruciate Ligament Injury Prevention Among Female Athletes.” Journal of Athletic Training. 2004 Oct-Dec; 39(4): 352–364.
  • Stein V, Li L et al. “Pattern of joint damage in persons with knee osteoarthritis and concomitant ACL tears.” Rheumatology International. 2012 May;32(5):1197-208.

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