Predictors of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction
Predictors of Radiographic Knee Osteoarthritis After Anterior Cruciate Ligament Reconstruction
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DOI：
10.1177/0363546511424720
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发表时间：
2011-12-01
影响因子：
4.8
通讯作者：
Irrgang, James J.
中科院分区：
文献类型：
--
作者：
Li, Ryan T.;Lorenz, Stephan;Irrgang, James J.
背景：有证据表明，单束前交叉韧带 (ACL) 重建并不能可靠地预防膝骨关节炎 (OA) 的发展。目的：本研究旨在确定单束 ACL 重建后放射学膝关节 OA 的总体患病率和危险因素。研究设计：病例对照研究；证据级别，3。方法：本回顾性队列研究纳入了 249 名接受过初次单束 ACL 重建的患者。一位骨科运动医学研究员使用 Kellgren-Lawrence (KL) 量表对后续 X 光片进行评分，以确定内侧、外侧和髌股间室的 OA 程度。如果与未受累膝关节相比，至少 1 个隔室中的 KL 评分存在至少 2 级差异或至少 2 个隔室中存在 1 级差异，则认为受累膝关节存在放射学 OA。所探讨的 OA 预测因素包括患者年龄、性别、体重指数 (BMI)、吸烟状况活动水平、ACL 重建之前或同时进行的半月板切除术、ACL 重建时存在的软骨损伤、移植物类型和来源、胫骨和股骨隧道位置、是否需要翻修以及随访时间长度。使用单变量和逐步多变量逻辑回归来确定与放射学膝关节 OA 相关的因素。结果：39% 的患者平均在术后 7.8 年出现放射学 OA。女性、BMI、受伤到手术的时间、内侧和髌股间室软骨病、既往内侧或外侧半月板切除术、同时内侧半月板切除术和随访时间长度与 ACL 手术后放射学膝关节 OA 相关。逐步多变量逻辑回归表明，既往内侧半月板切除术（95% 置信区间 [CI]，1.39-6.85）、2 级或以上内侧软骨病（95% CI，1.27-6.73）、随访时间长度（95% CI，1.07-1.24）和 BMI（超重 95% CI，1.08-3.84；肥胖） 95% CI，1.34-7.80）是膝关节 OA 的最佳预测因子。结论：尽管松弛和不稳定性减少，活动和参与度有所改善，但与一般人群相比，接受 ACL 重建的个体仍然面临着发生膝关节 OA 的高风险。 ACL 重建后膝关节 OA 的最强预测因素是肥胖和内侧间室 2 级或更大的软骨病。这些结果可能有助于识别 ACL 重建后有 OA 风险的患者。
Background: Evidence suggests that single-bundle anterior cruciate ligament (ACL) reconstruction does not reliably prevent the development of knee osteoarthritis (OA).Purpose: This study was conducted to determine the overall prevalence of and risk factors for the development of radiographic knee OA after single-bundle ACL reconstruction.Study Design: Case control study; Level of evidence, 3.Methods: There were 249 individuals who had undergone primary single-bundle ACL reconstruction included in this retrospective cohort study. Follow-up radiographs were scored by a single orthopaedic surgery sports medicine fellow using the Kellgren-Lawrence (KL) scale to determine the degree of OA in the medial, lateral, and patellofemoral compartments. Radiographic OA of the involved knee was considered to be present if, compared with the noninvolved knee, there was at least a 2-grade difference in the KL score in at least 1 compartment or a 1-grade difference in at least 2 compartments. Predictors of OA that were explored included patient age, sex, body mass index (BMI), smoking status activity level, meniscectomy before or concurrent with ACL reconstruction, chondral injury present at the time of ACL reconstruction, graft type and source, tibial and femoral tunnel positions, need for revision, and length of follow-up. Univariable and stepwise multivariable logistic regressions were used to identify factors that were associated with radiographic knee OA.Results: Thirty-nine percent of the patients had radiographic OA an average of 7.8 years after surgery. Female sex, BMI, time from injury to surgery, medial and patellofemoral compartment chondrosis, prior medial or lateral meniscectomy, concurrent medial meniscectomy, and length of follow-up were associated with radiographic knee OA after ACL surgery. Stepwise multivariable logistic regression indicated that prior medial meniscectomy (95% confidence interval [CI], 1.39-6.85), grade 2 or greater medial chondrosis (95% CI, 1.27-6.73), length of follow-up (95% CI, 1.07-1.24), and BMI (overweight 95% CI, 1.08-3.84; obese 95% CI, 1.34-7.80) were the best set of predictors of knee OA.Conclusion: Despite reduced laxity and instability and improved activity and participation, individuals who have undergone ACL reconstruction are still at high risk for developing knee OA compared with the general population. The strongest predictors of knee OA after ACL reconstruction were obesity and grade 2 or greater chondrosis in the medial compartment. These results may aid in identifying patients at risk for OA after ACL reconstruction.