Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.
Are articular cartilage lesions and meniscus tears predictive of IKDC, KOOS, and Marx activity level outcomes after anterior cruciate ligament reconstruction? A 6-year multicenter cohort study.
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DOI：
10.1177/0363546514525910
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发表时间：
2014-05
期刊：
影响因子：
--
通讯作者：
Spindler KP
中科院分区：
文献类型：
--
作者：
Cox CL;Huston LJ;Dunn WR;Reinke EK;Nwosu SK;Parker RD;Wright RW;Kaeding CC;Marx RG;Amendola A;McCarty EC;Spindler KP
确定ACL重建（ACLR）后不良结局的风险因素对预后和未来治疗非常重要。本研究的目的是确定关节软骨和踝关节变量是否可预测ACLR后3种经验证的运动结果工具。我们假设关节软骨病变和半月板撕裂/治疗是ACLR后6年IKDC、KOOS（所有5个分量表）和马克思活动水平的预测因子。前瞻性队列，1级2002年至2004年，前瞻性入组了1512例ACLR受试者，并在入组、2年和6年时完成IKDC、KOOS和马克思活动评分进行纵向随访。建立逻辑回归模型，纳入患者人口统计学、手术技术、关节软骨损伤和半月板撕裂/治疗的变量，以确定6年时IKDC、KOOS和马克思的预测因子（风险因素）。我们对86%（1307/1512）的队列在6年时完成了最低随访。该队列为56%的男性，入组时的中位年龄为23岁，其中76%报告了非接触性损伤机制。手术时伴随病理学的发生率包括：关节软骨（股骨内侧髁[MFC]-25%，股骨外侧髁[LFC]-20%，胫骨内侧平台[MTP]-6%，胫骨外侧平台[LTP]-12%，髌骨-20%，股骨髁-9%）和股骨（内侧-38%，外侧-46%）。关节软骨病变和椎间盘撕裂是IKDC和KOOS 6年结局的重要预测因素。3级或4级关节软骨病变（不包括髌骨）显著降低了6年时的IKDC和KOOS评分。IKDC表现出更差的结局，在MFC、MTP和LFC上存在3-4级软骨损伤。同样，KOOS受到软骨损伤的负面影响。马克思活动减少的唯一显著预测因素是MFC上存在4级病变。外侧半月板修复与较差的结果无关，但内侧半月板修复预测IKDC和KOOS评分较差。外侧半月板撕裂单独存在可显著改善预后。内侧半月板的小部分切除术（<33%）预后较差，但相反，内侧或外侧半月板的较大切除术（>50%）改善了预后。与以前的研究类似，其他显著的低结局评分的预测因子是较低的基线评分、较高的BMI、较低的教育水平、吸烟和ACL翻修。ACLR时的关节软骨损伤和髋臼撕裂/治疗是ACLR后6年IKDC和KOOS评分的显著预测因素。类似地，具有4级MFC病变显著降低了患者6年时的马克思活动水平评分。
Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Prospective cohort, Level 1 Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion on the MFC. Lateral meniscus repairs did not correlate with inferior results, but medial meniscus repairs predicted worse IKDC and KOOS scores. Lateral meniscus tears left alone significantly improved prognosis. Small partial meniscectomies (<33%) on the medial meniscus fared worse, but conversely, larger excisions (>50%) on either the medial or lateral menisci improved prognosis. Analogous to previous studies, other significant predictors of lower outcome scores were lower baseline scores, higher BMI, lower education level, smoking, and ACL revisions. Both articular cartilage injury and meniscal tears/treatment at the time of ACLR were significant predictors of IKDC and KOOS scores 6 years following ACLR. Similarly, having a grade 4 MFC lesion significantly reduced a patient’s Marx activity level score at 6 years.
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影响因子：
4.8
作者：
Dunn, WR;Wolf, BR;Spindler, KP
通讯作者：
Spindler, KP
DOI：
10.1016/s0749-8063(97)90124-9
发表时间：
1997-08-01
影响因子：
4.7
作者：
Curl, WW;Krome, J;Poehling, GG
通讯作者：
Poehling, GG
影响因子：
3.8
作者：
Melton, J. T. K.;Murray, J. R.;Thomas, N. P.
通讯作者：
Thomas, N. P.
影响因子：
3.3
作者：
Kaeding CC;Aros B;Pedroza A;Pifel E;Amendola A;Andrish JT;Dunn WR;Marx RG;McCarty EC;Parker RD;Wright RW;Spindler KP
通讯作者：
Spindler KP
影响因子：
3.8
作者：
Claes, Steven;Hermie, Laurens;Verdonk, Peter
通讯作者：
Verdonk, Peter