Does Early Joint Trauma Lead to Osteoarthritis?

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

The complex structure of synovial joints is comprised of periarticular and subchondral bone, articular cartilage, synovial membrane, joint capsule, and periarticular musculature. It is within this complex that osteoarthritis develops. Previous research suggests that trauma or pathology compromising the integrity of one, or more of these synovial structures may contribute to the development of osteoarthritis. Few studies have specifically examined the association between injuries in young adults and their subsequent risk for this debilitating condition.

Gelber et al   [1] report on investigator–recorded prior and current injury status in a total of 1321 persons who graduated from the Johns Hopkins School of Medicine in Baltimore, Maryland, between 1948 and 1964, with the average age of 22 years. Subsequent trauma and specific arthritis sites were assessed using annual self–administered questionnaires. Injury was defined as "a report of trauma to the knee or hip joint (ICD-9 codes 715.95 and 715.96), including internal derangement or fracture."

After an average follow–up period of 36 years, 141 subjects reported injuries (111 knee injuries alone, 16 hip injuries alone, and 14 injuries of both), with 96 of those subjects developing osteoarthritis. By 65 years of age, 13.9% of participants reporting a knee injury in youth or young adulthood had developed osteoarthritis in the knee, comparing with only 6% of those without any such injury. Overall, prior joint injury significantly increased the risk for later–life osteoarthritis at the specific injury site.

The authors conclude that adolescents and young adults with traumatic injury are at substantially increased risk for osteoarthritis in their later years, and these patients comprise a "high risk" group. The authors suggest joint–stabilizing braces and exercises to minimize further damage in these circumstances. They also urge "...use of proper sports equipment under safe conditions to prevent joint injuries and decrease their long–term sequelae".

Roos et al   [2] reported previously that surgical removal of a meniscus, following a knee injury, represents a significant increased risk factor for tibiofemoral osteoarthritis. With this risk of increasing arthritic outcome with surgery, perhaps a more conservative approach, like chiropractic adjusting of the injured joint-complex, coupled with a conservative rehabilitative protocol should be explored.

Biedebach, Brantingham, and Snyder write that "Spinal Manipulation May Help Reduce Spinal Degenerative Joint Disease and Disability" in their 2 part series.   Part I   (http://www.chiroweb.com/archives/12/07/12.html ) reports the relationship between fixation and loss of normal range of motion (ROM), and ties it to the development of arthritic changes, as reported in the scientific literature.

Part II   (http://www.chiroweb.com/archives/12/09/11.html) reports the improvements in ROM and function following spinal manipulation, and suggests that additional research is needed to determine exactly what degree of hypomobility must develop to initiate the onset of degenerative joint disease. There are 86 citations (with some overlap) which support their contention that osteoarthritis can be halted and even reversed with spinal adjusting.


Disc Degeneration: Reversibility is Possible in Spinal Osteoarthritis [3]

O.J. Ressel, B.Se., D.C., ICA Internat Rev Chiro 1989 (Mar); 45 (2): 39–61

This is a must read article for the chiropractic clinician. There are 329 references supporting the author's hypothesis. Dr. Ressel points out that his experience “has shown that most 'adult' problems begin in the early years. In the child, for instance, neuromuscular development represents a critical period of time when the young developing nervous system assimilates, differentiates, and adapts to external and internal signals.”

Dr. Ressel brings to focus a whole new area supporting the need for chiropractic care of children. Can you imagine an adult nervous system adapted to abnormal early programming that it considers normal? The abnormally developed neurospinal paradigm becomes dominant in the adaptive abilities of the organism. Certainly, as time goes on, the uncorrected Vertebral Subluxation Complex traumatic residuals collect in the form of spinal degeneration and the lessened ability of the nervous system to process date in a positive constructive manner. Not only does the patient's general health index deteriorate, the Vertebral Subluxation Complex itself becomes much more difficult to correct.

Dr. Ressel continues, “These adaptive responses are remembered, and the young nervous system is conditioned for future response. This process of 'neurological learning' or 'programming' of the central nervous system with respect to locomotion, posture, proprioception, and body kinetics takes place in a few short months.”

Yes, the nervous system “learns” that the Vertebral Subluxation Complex is “normal” within a few short months after its first episode and continually learns that the downhill spiral of the neurospinal paradigm is to be considered normal. Dr. Ressel comments, “Parents should be urged to have their children examined at an early age. Once their health status is addressed, it should be enhanced and monitored.”

The responsibility for early and ongoing chiropractic care is a heavy burden for the doctor of chiropractic. We see that the only method available for this to be widely accepted by the health care consumer is for an effective, philosophically and scientifically oriented patient education program. "

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References:

1. Allan C. Gelber, MD, MPH, PhD; Marc C. Hochberg, MD, MPH; Lucy A. Mead, ScM; Nae-Yuh Wang, MS, PhD; Fredrick M. Wigley, MD; and Michael J. Klag, MD, MPH
   Joint Injury in Young Adults and Risk for Subsequent Knee and Hip Osteoarthritis
   Annals of Internal Medicine 2000 (Sep 5);   133 (5):   321–328

2. Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K, Lohmander LS
   Knee Osteoarthritis After Meniscectomy:   Prevalence of Radiographic Changes After Twenty-one Years, Compared with Matched Controls
   Arthritis Rheum 1998;   41 (4) Apr:   687–93

3. Ressel, O.J. Disc Regeneration: Reversibility is Possible in Spinal Osteoarthritis
   ICA Internat Rev Chiro 1989 (Mar);   45 (2):   39–61

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