Effects of Initial Graft Tension and Patient Sex on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 10- to 12-Year Follow-up.
Effects of Initial Graft Tension and Patient Sex on Knee Osteoarthritis Outcomes After ACL Reconstruction: A Randomized Controlled Clinical Trial With 10- to 12-Year Follow-up.
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DOI：
10.1177/03635465221124917
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发表时间：
2022-11
期刊：
影响因子：
--
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中科院分区：
文献类型：
--
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ACL 移植物固定期间施加的“初始移植物张力”可能会促进创伤后骨关节炎 (PTOA)。本研究旨在评估初始移植物张力和患者性别对前交叉韧带重建 (ACLR) 后 10 至 12 年 PTOA 结局的影响。假设结果不会存在基于群体或性别的差异。随机对照临床试验。患者被随机分配至初始移植物张力较低或较高的 ACLR 组。术后 10 至 12 年评估结果，并与匹配的未受伤对照组进行比较。结果包括临床（AP 膝关节松弛度测量、国际膝关节文献委员会 [IKDC] 检查评分）、功能性（单腿跳跃距离）、患者报告（膝关节损伤和骨关节炎结果评分 [KOOS]、Short Form-36 [SF-36]、Tegner 活动水平、患者满意度）和 PTOA 成像（国际骨关节炎研究协会 [OARSI] 放射照相评分、全器官）磁共振成像评分 [WORMS]）评估。使用双向混合模型方差分析来评估紧张组和对照组之间以及女性和男性之间的结果差异。两个紧张组的 IKDC 检查 (P≤.021)、KOOS（疼痛、ADL、运动和 QOL 分量表）(P≤.049) 和 WORM 差异评分 (P≤.042) 结果均低于对照组。低张力组的 KOOS 症状得分 (P=.016) 和 OARSI 差异得分 (P=.015) 低于对照组。在高压组中，指数肢体的 AP 松弛 (P=.030) 和跳跃缺陷 (P=.011) 得分低于对侧肢体。在两个张力组的 WORMS (P≤.050) 和低张力组的 OARSI 评分 (P=.001) 中也观察到了这一结果。相对于女性，男性具有较高的平均值±标准误差 Tegner [男性 = 5.49 (±1.88) vs. 女性 = 4.45 (±1.65)] 和较差的 OARSI 差异评分 [男性 = 1.89 (±5.38) vs. 女性 =.244 (±.668)]（分别为 P=.007 和 .034）。然而，紧张组之间的任何测量结果均未发现显着差异。总体而言，无论初始移植物张力如何，ACLR 都无法预防 PTOA。然而，接受较低初始移植张力治疗的男性患 PTOA 的风险可能更大。这些结果并不支持 ACLR 后 10 至 12 年结果没有性别差异的假设。结果表明，ACLR 后男性可能面临更严重 PTOA 的风险，这可能与 ACL 损伤后的临床管理相关。
The “initial graft tension” applied during ACL graft fixation may promote posttraumatic osteoarthritis (PTOA). This study sought to assess the impact of initial graft tension and patient sex on PTOA outcomes at 10 to 12 years post-anterior cruciate ligament reconstruction (ACLR). The hypotheses were that there would be no group- or sex-based differences in outcomes. Randomized Controlled Clinical trial. Patients were randomized to ACLR with a low or high initial graft tension. Outcomes were evaluated at 10 to 12 years postoperatively and compared with a matched, uninjured control group. Outcomes included clinical (AP knee laxity measurement, International Knee Documentation Committee [IKDC] examination score), functional (1-legged hop for distance), patient-reported (Knee injury and Osteoarthritis Outcome Score [KOOS], Short Form-36 [SF-36], Tegner activity level, patient satisfaction), and PTOA imaging (Osteoarthritis Research Society International [OARSI] radiographic score, Whole-Organ Magnetic Resonance Imaging Score [WORMS]) assessments. Two-way mixed model analyses of variance were used to evaluate differences in outcomes between tension groups and the control group and between females and males. Both tension groups scored worse than the control group for the IKDC examination (P≤.021), KOOS (Pain, ADL, Sport, and QOL subscales) (P≤.049), and WORM difference score (P≤.042) outcomes. The low-tension group scored worse than the control group for KOOS-symptoms (P=.016) and the OARSI difference score (P=.015). The index limb had worse scores than the contralateral limb within the high-tension group for AP laxity (P=.030) and hop deficit (P=.011). This result was also observed within both tension groups for the WORMS (P≤.050) and within the low-tension group for the OARSI score (P=.001). Males had higher mean±standard error Tegner [males=5.49 (±1.88) vs. females=4.45 (±1.65)] and worse OARSI difference scores [males=1.89 (±5.38) vs. females=.244 (±.668)] relative to females (P=.007 and .034, respectively). However, no significant differences were detected between tension groups for any of the outcomes measured. Overall, ACLR failed to prevent PTOA regardless of initial graft tension. However, males treated with a low initial graft tension may be at greater risk for PTOA. These results do not support the hypothesis of no sex differences in outcomes at 10 to 12 years post-ACLR. The results suggest that males may be at risk for worse PTOA post-ACLR, which may be relevant to clinical management post-ACL injury.
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影响因子：
3.8
作者：
Bodkin, Stephan G.;Werner, Brian C.;Hart, Joseph M.
通讯作者：
Hart, Joseph M.
影响因子：
4.8
作者：
Freedman, KB;D'Amato, MJ;Bach, BR
通讯作者：
Bach, BR
DOI：
10.1002/jor.23557
发表时间：
2017-07
期刊：
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
影响因子：
--
作者：
Jones MH;Spindler KP
通讯作者：
Spindler KP
影响因子：
4.8
作者：
Bush-Joseph, CA;Hurwitz, DE;Andriacchi, TP
通讯作者：
Andriacchi, TP
影响因子：
2
作者：
Friel NA;Chu CR
通讯作者：
Chu CR