Knee Crepitus as a Short-Term Indicator of Osteoarthritis After ACL Reconstruction: Study
Canada: Researchers have found in a new study that self-reported knee crepitus was associated with an increased risk of osteoarthritis at 1 year following ACL reconstruction. However, crepitus did not predict progression or worsening of osteoarthritis at 5 years post-surgery, suggesting its value may be limited to short-term risk assessment rather than long-term prognosis.
Knee crepitus—commonly described as cracking, grinding, or popping sensations during joint movement—is frequently reported by young adults after traumatic knee injuries. While often dismissed as benign, crepitus has raised concern as a potential early indicator of osteoarthritis (OA), particularly in individuals who undergo anterior cruciate ligament reconstruction (ACLR), a group already known to be at elevated risk for early-onset OA.
In a study published in Arthritis Care & Research, Jamon L. Couch from La Trobe University and the Australian International Olympic Committee Research Centre in Melbourne, along with colleagues from Arthritis Research Canada, examined whether knee crepitus is linked to structural OA changes and patient-reported outcomes following traumatic knee injury. The study followed 112 young adults (median age 28 years), including 41 women, who had undergone ACL reconstruction.
One year after surgery, participants self-reported the presence or absence of knee crepitus using a validated item from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Structural features of osteoarthritis in both the patellofemoral and tibiofemoral joints—including cartilage damage, osteophytes, and bone marrow lesions—were assessed using magnetic resonance imaging (MRI) at one and five years post-ACLR. Patient-reported pain, knee-related quality of life, and function were evaluated using KOOS subscales and the International Knee Documentation Committee (IKDC) subjective assessment.
The study led to the following notable findings:
- Knee crepitus at one year was linked to full-thickness patellofemoral cartilage lesions.
- Crepitus likely reflects early structural joint damage after ACL reconstruction.
- It was not associated with worsening osteoarthritis over five years.
- Crepitus showed limited value for predicting long-term OA progression.
- Participants with crepitus reported more pain at one year.
- Knee-related quality of life was poorer in those with crepitus.
- Self-reported knee function was worse at one year in the crepitus group.
- Pain and function improved more over time in participants with crepitus.
- By five years, outcome differences between groups had largely narrowed.
The authors emphasize that while knee crepitus may signal early cartilage damage and symptom burden after ACL reconstruction, it should not be interpreted as a predictor of inevitable osteoarthritis progression. Instead, crepitus may serve as a short-term clinical marker identifying individuals who could benefit from closer monitoring or targeted rehabilitation in the early post-injury period.
Overall, the study highlights the importance of distinguishing between early indicators of joint pathology and long-term prognostic factors in young adults with traumatic knee injuries. Understanding the limited predictive role of knee crepitus may help clinicians provide more accurate counseling and avoid unnecessary concern about long-term osteoarthritis outcomes.
Reference:
Couch JL, Patterson BE, Crossley KM, Guermazi A, King MG, De Oliveira Silva D, Whittaker JL, Girdwood MA, Culvenor AG. Knee Crepitus and Osteoarthritis Features in Young Adults Following Traumatic Knee Injury. Arthritis Care Res (Hoboken). 2025 Aug 25. doi: 10.1002/acr.25637. Epub ahead of print. PMID: 40855080.
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