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Low Vitamin D resulted in 1.8X increase in ACL knee tears in next 2 years – April 2023

A Diagnosis of Vitamin D Deficiency is Associated with Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure

Arthroscopy. 2023 Apr 29;S0749-8063(23)00375-4. doi: 10.1016/j.arthro.2023.04.011  PDF behind paywall
J Alex Albright 1, Kenny Chang 2, Rory A Byrne 3, Matthew Quinn 3, Ozair Meghani 3, Alan H Daniels 3, Brett D Owens 3

Purpose: This study aims to characterize the association between a diagnosis of hypovitaminosis D and primary anterior cruciate ligament (ACL) tear, primary ACL reconstruction (ACLR), and revision ACLR in different sex and age cohorts.

Methods: In this retrospective cohort study of the PearlDiver claims database, records were queried between January 1st, 2011 to October 31st, 2018 for all patients aged 10 to 59 who received a diagnosis of hypovitaminosis D. Rates of primary ACL tears, primary reconstruction, and revision reconstruction were calculated for sex- and age-specific cohorts and compared to a control of patients without a diagnosis of hypovitaminosis D. Incidence rates for primary ACL injuries were calculated, and multivariable logistic regression was used to compare rates of ACL injury, primary reconstruction, and revision reconstruction while controlling for age, sex, Charlson comorbidity index, and several other comorbidities.

Results: Among the 328,011 patients (mean age 41.9 ± 12.6 years, 65.8% female) included in both the hypovitaminosis D and control cohorts, the incidence of ACL tears was 115.2 per 100,000 person-years (95% CI, 107.2 - 123.7), compared to 61.0 (95% CI, 55.2 - 67.2) in the demographics and comorbidity matched control cohort.
The study cohort was significantly more likely to suffer an ACL tear over a

  • one- (aOR = 1.67, 95% CI, 1.41 - 1.99, p < 0.001) and
  • two-year (aOR = 1.81, 95% CI, 1.59 - 2.06, p < 0.001) period.

This trend remained for both males at the one- (aOR = 1.66, 95% CI, 1.29 - 2.14, p < 0.001) and two-year (aOR = 1.68, 95% CI, 1.37 - 2.06, p < 0.001) mark and females at the one- (aOR = 1.69, 95% CI, 1.33 - 2.14, p < 0.001) and two-year (aOR = 1.80, 95% CI, 1.51 - 2.14, p < 0.001) mark. Finally, vitamin D-deficient patients had a significantly increased likelihood of undergoing a revision ACL reconstruction within two years of a primary reconstruction (aOR = 1.28, 95% CI, 1.05 - 1.55, p = 0.012).

Conclusion: This study reports an association between patients previously diagnosed with hypovitaminosis D and significantly increased rates of both index ACL tears (81% increase within two years of diagnosis) and revision ACLR (28% within two years). These results identify a population with increased odds of injury and provide valuable knowledge as we expand our understanding of the relationship between vitamin D and musculoskeletal health.

Regarding “A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure” - Dec 2023

DOI:https://doi.org/10.1016/j.arthro.2023.07.033
Tyler Barker, Ph.D.

It was with great interest I read the article entitled “A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Anterior Cruciate Ligament Tears and Reconstruction Failure” by Albright and colleagues.1 From a large, well-designed, retrospective study, Albright and colleagues1 identify an increase in index anterior cruciate ligament (ACL) tears and revision ACL surgery rates with hypovitaminosis D. The inherent limitations of a retrospective protocol are discussed therein.1 It is noteworthy, however, to highlight a significant strength of the study that has been lacking in this overarching field of research. Specifically, Albright and colleagues1 assessed vitamin D status before trauma and related vitamin D status to ACL injury and revision surgery rates. This is significant because Albright and colleagues1 controlled for the potentially deleterious and confounding influence of trauma-induced inflammation on serum 25(OH)D concentrations2, 3, 4 by assessing vitamin D status before an ACL injury.

The systemic inflammatory response to an ACL injury (and surgery) is characterized by transient perturbations in diverse cytokines.5, 6, 7 In addition to regulating host defenses and cell signaling, cytokines moderate the enzymatic machinery of vitamin D metabolism in peripheral blood immune cells.2,8,9 Thus it is plausible that cytokine alterations in the circulation after an ACL injury contribute to the conversation of 25(OH)D to other vitamin D metabolites (e.g., 1,25-dihydroxyvitamin D).6 This, in turn, temporally compromises serum 25(OH)D concentrations and potentially confounds both the interpretation of vitamin D status4,10,11 and its subsequently inferred association with desired outcomes or variables.

The unique findings by Albright and colleagues1 also establish the basis for future vitamin D research in those at risk for an ACL injury and outcomes after an ACL injury and surgery. For example, taking into consideration the recent association of index ACL tears with low vitamin D1 and concomitant knee structure damage with an ACL injury,12 it is reasonable to presume that low serum 25(OH)D exacerbates knee structure damage (e.g., meniscus, cartilage, or both) with an ACL injury. Second, low vitamin D and ACL injuries are related to the progression in knee osteoarthritis and post-traumatic knee osteoarthritis (PTOA), respectively.13,14 However, it is unknown whether low vitamin D contributes to the development and progression in PTOA after an ACL injury. Third, low vitamin D associates with muscular weakness after an ACL injury15 and with muscular atrophy and weakness in other conditions.16, 17, 18 Quadriceps atrophy and weakness are predominant impairments that continue to challenge the rehabilitative efforts after an ACL injury and surgery, and it is unknown if correcting hypovitaminosis D diminishes muscular impairments and improves outcomes after an ACL injury.

Albright and colleagues1 are commended for performing an outstanding study that extends our current knowledge. Future research assessing the impact of trauma induced alterations on serum 25(OH)D and determining whether correcting hypovitaminosis D improves outcomes after an ACL injury are warranted.
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Items found: 48
Title Modified
400,000 IU of Vitamin D before surgery should cost-effectively reduce infection after knee replacement – May 2020 15 Nov, 2024
ACL Knee surgery increases risk of subsequent Knee Osteoarthritis by up to 2X (both low D) – Sept 2024 19 Sep, 2024
Total knee arthroplasty – worse outcome if low vitamin D – many studies 05 Apr, 2024
Low Vitamin D resulted in 1.8X increase in ACL knee tears in next 2 years – April 2023 21 Dec, 2023
Knee osteoarthritis treated by Vitamin D - many studies 13 Dec, 2023
Knee Osteoarthritis treated by vitamin D if use more than 2,000 IU daily or non-daily high dose – meta-analysis Aug 2023 21 Aug, 2023
Ageing faster and more knee pain are associated with low vitamin D – March 2022 08 Mar, 2022
I needed more than Vitamin D to treat my knee osteoarthritis 06 Nov, 2021
Oral Vitamin D much better than injection (after Knee Arthroplasty in this case) – Sept 2021 06 Sep, 2021
Knee osteoarthritis helped by Low Level Laser Therapy 02 Nov, 2020
Knee osteoarthritis: Vitamin D is the 4th best treatment – meta-analysis Oct 2020 21 Oct, 2020
Less Knee Osteoarthritis if take more Vitamin D – 8 MRI confirmations – Nov 2018 10 Oct, 2018
Knee replacement not helped by 2,000 IU of vitamin D (both too late and too little) – RCT July 2018 11 Jul, 2018
Knee Osteoarthritis benefited by 20 ng of Vitamin D for 5 years – RCT July 2018 10 Jul, 2018
Only 1600 IU of Vitamin D to be given following knee and hip replacement trial – 2020 07 Jul, 2018
Knee Arthroplasty complications were 2 X more likely if low vitamin D -May 2018 05 May, 2018
Fewer Complications Following Revision Hip and Knee Arthroplasty in Patients with Normal Vitamin D Levels – March 2017 05 May, 2018
Knee pain and depression reduced by monthly 50,000 IU vitamin D – RCT April 2018 21 Apr, 2018
If You Tear a Knee Ligament, Arthritis Is Likely to Follow in 10 Years (both are related to low Vitamin D) – Nov 2017 08 Nov, 2017
More pain after knee surgery if low vitamin D – Oct 2015 26 Aug, 2017
Knee osteoarthritis helped by vitamin D2 (40,000 IU weekly raised 57 % above 30 ng) June 2017 29 Jul, 2017
Knee Osteoarthritis (Radiographic ) 3X less if have lots of Magnesium – May 2015 29 Jul, 2017
Reduced knee osteoarthritis if consistently supplement with vitamin D for 2 years – April 2017 29 Jul, 2017
Knee osteoarthritis treated with vitamin D, weekly 50,000 IU – May 2015 20 Jul, 2017
Knee osteoarthritis not helped by Vitamin D (when you ignore vitamin D levels) – April 2017 25 Apr, 2017
Knee osteoarthritis strongly associated with low Boron – 2015 24 Mar, 2017
4 fewer days in hospital after hip or knee replacement if good level of vitamin D – June 2016 14 Mar, 2017
Knee surgery reduced vitamin D by 40 percent in 2 days – May 2011 14 Mar, 2017
Knee osteoarthritis pain reduced by 60,000 IU monthly vitamin D following loading dose – RCT Nov 2013 24 Dec, 2016
Teenagers having sticky, painful knees (Osteochondrosis Dissecans) virtually always have low vitamin D – Dec 2016 24 Dec, 2016
Synovitis (knee osteoarthritis) associated with low vitamin D – Dec 2016 21 Dec, 2016
Vitamin D increasing muscle strength may reduce knee pain – Feb 2016 22 Nov, 2016
Hypothesis- Knee osteoarthritis is reduced by vitamin D increasing level of nitric oxide – Dec 2013 06 Oct, 2016
Good evidence for knee osteoarthritis and vitamin D, unsure of other OA – Review March 2013 06 Oct, 2016
Knee osteoarthritis reduced somewhat by 50,000 IU vitamin D monthly (need more) – RCT Aug 2015 08 Mar, 2016
Knee pain in seniors predicted by low vitamin D 5 years before – Feb 2014 27 Oct, 2015
Knee joint space narrowing (Osteoarthritis) 1.5X worse with low vitamin D – meta-analysis Sept 2015 03 Oct, 2015
Will knee osteoarthritis be prevented with 1700 IU of vitamin D – proposed RCT 08 Aug, 2015
Knee osteoarthritis more painful if low vitamin D, especially among obese – Jan 2015 12 Apr, 2015
Knee Osteoarthritis 3.2X more likely to get worse if low Vitamin D and high PTH – Dec 2014 23 Feb, 2015
Knee osteoarthritis 2.3 X more likely to get worse if low level of vitamin D – Dec 2014 07 Oct, 2014
Pro-inflammatory cytokines cause the 74 percent drop in vitamin D after knee arthroplasty – Feb 2014 30 Sep, 2014
Blacks had lower vitamin D and more quantifiable pain than whites with knee osteoarthritis – Nov 2012 11 May, 2014
Teenage knee injury 4X increase in last decade in Philadelphia – Oct 2011 12 Jan, 2014
Probability of knee osteoarthritis up 50 percent if 20 ng less vitamin D – Nov 2011 10 Nov, 2012
Knee osteoarthritis associated with low vitamin D for those under age 55 – Dec 2010 10 Nov, 2012
Higher vitamin D helps regain muscle strength after knee surgery – July 2011 01 Sep, 2011
Knee Osteoarthritis pain cut in half by eating sesame seed powder for 2 months - Oct 2019 No value for &#039;modification_date_major&#039;
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Low Vitamin D resulted in 1.8X increase in ACL knee tears in next 2 years – April 2023        
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