Secondary osteoarthritis (OA) of the knee is a degenerative joint condition that arises due to certain causative factors, with trauma as one of the main etiologies, especially in productive age.
Osteoarthritis Risk Factors
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Knee trauma, especially those causing cartilage damage, ligaments (e.g. ACL), or intra-articular fractures, has been shown to be an important predisposing factor in the development of secondary OA. Traumatic changes in joint structures can disrupt balance, trigger ongoing inflammation, and accelerate the degenerative process in joint cartilage.
A Closer Look at the Case That Happened
Design
A descriptive observational study based on case review of patients aged 25–45 years with a history of previous knee trauma and currently diagnosed with secondary OA based on clinical and radiological criteria.
Inclusion Criteria
- Age 25–45 years
- History of knee trauma (ACL rupture, intra-articular fracture, patellar dislocation)
- Chronic pain and limited function of the knee joint
- Supportive radiological results
Exclusion Criteria
- Primary OA without a history of trauma
- Inflammatory arthritis (RA, gout)
Case Summary Results
Of the 12 patients who met the inclusion criteria:
- 75% experience secondary OA after ACL injury.
- 42% had a history of tibial plateau or patellar fracture.
- 33% showed symptom onset within 3–5 years post-trauma.
- 100% showed radiological signs of OA grade ≥ grade 2 (Kellgren-Lawrence).
- 70% work in the physical sector (laborers, athletes, field workers).
Impact of Knee Trauma
Knee trauma causes mechanical and biological imbalances in the joint, initiating cartilage and synovial membrane damage. Biomechanical studies have shown that joint instability after ACL rupture causes abnormal stress distribution, triggering degenerative changes.
The degenerative process begins subclinically and progresses progressively, causing pain, limited mobility, and loss of joint function. Delayed or inadequate conservative treatment contributes to accelerated progression of OA.
Exacerbating Risk Factors:
- Obesity
- Repetitive heavy physical activity
- Non-compliance with post-traumatic rehabilitation programs
- Delays in diagnosis and orthopedic intervention
Clinical Management
Integrated Approach:
- Early post-traumatic rehabilitation
- Timely internal fixation for intra-articular fractures
- Ligament reconstruction in case of chronic instability
- Intra-articular injections (viscosupplements, PRP)
- Total Knee Replacement (TKR) in advanced cases refractory to conservative therapy
Prevent Before It's Too Late
Knee trauma is a major predisposing factor for secondary OA in the productive age group. Clinical awareness, early diagnosis, and aggressive management of intra-articular injuries are essential to prevent or delay the progression of OA. Secondary prevention through patient education and rehabilitative interventions are key to minimizing the long-term impact on joint function and quality of life.
Article written by dr. Othdeh Samuel Halomoan, Sp.OT (Orthopedic & Traumatology Specialist Doctor, EMC Cibitung & Pekayon Hospital).