Knee Crepitus Linked to Early Cartilage Defects in Post-ACL Reconstruction
Self-reported knee crepitus at 1 year after anterior cruciate ligament reconstruction (ACLR) signals early cartilage injury but does not predict progressive osteoarthritis (OA) features over the following 4 years, according to a recent cohort study.
Investigators examined the relationship between knee crepitus and structural OA in young adults following ACLR. The study followed 112 participants (median age 28 years; 41 female) who completed the Knee injury and Osteoarthritis Outcome Score (KOOS) 1 year after surgery, reporting the presence or absence of knee crepitus. Magnetic resonance imaging was used to evaluate patellofemoral and tibiofemoral OA features—including cartilage lesions, osteophytes, and bone marrow lesions—at 1 and 5 years post-ACLR. Outcomes of pain, quality of life (QoL), and function were measured using KOOS subscales and the International Knee Documentation Committee evaluation.
At 1 year, self-reported knee crepitus was strongly associated with full-thickness patellofemoral cartilage lesions (prevalence ratio 2.70, 95% CI 1.41–6.39). However, crepitus was not linked to worsening structural OA features between years 1 and 5. Participants with crepitus reported worse pain (β -6.42, 95% CI -10.47 to -2.36), poorer QoL (β -10.39, 95% CI -18.58 to -2.20), and reduced function (β -5.49, 95% CI -10.92 to -0.06) at 1 year compared with those without crepitus. Notably, individuals with crepitus experienced greater improvements in pain and function from years 1 to 5, though QoL impairments persisted.
These findings suggest that self-reported crepitus following ACLR reflects early patellofemoral cartilage damage and poorer short-term outcomes but does not portend progressive structural degeneration over 5 years. Clinicians may consider patient-reported crepitus as an indicator of early cartilage pathology and reduced function in the early postoperative period, though it may not serve as a reliable predictor of long-term structural progression.
Reference:
Couch JL, Patterson BE, Crossley KM, et al. Knee crepitus and osteoarthritis features in young adults following traumatic knee injury. *Arthritis Care Res*. Published online August 25, 2025. doi:10.1002/acr.25637.
