Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis
Is osteoarthritis an inevitable consequence of anterior cruciate ligament reconstruction? A meta-analysis
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DOI：
10.1007/s00167-012-2251-8
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发表时间：
2013-09-01
影响因子：
3.8
通讯作者：
Verdonk, Peter
中科院分区：
文献类型：
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作者：
Claes, Steven;Hermie, Laurens;Verdonk, Peter
虽然早期骨关节炎(OA)的发生通常与前交叉韧带(ACL)重建史有关，但其在这些患者中的确切患病率仍不清楚。本研究的目的是回顾目前关于自体前交叉韧带重建术后长期放射学结果的文献，并随后进行荟萃分析，以获得平均术后10年的骨性关节炎的循证患病率。此外，本报告的目的是确定半月板状态与前交叉韧带重建膝关节中放射学骨性关节炎的发生之间的关系。对PubMed MEDLINE、EMBASE和Cochrane图书馆数据库中的文献进行系统综述，以确定所有关于自体前交叉韧带重建后放射学结果的研究，随访至少10年。进行荟萃分析，以获得骨性关节炎的平均患病率，以及半月板切除术和未手术的患者之间的差异。考虑的研究估计是对数转换的优势和优势比，后者表示半月板切除对OA的影响。共有16项研究可纳入荟萃分析，占1978至1997年间进行的1554例前交叉韧带重建。在这些膝关节中，453个(28%)显示有骨关节炎的放射征象(IKDC C级或D级)。此外，接受半月板切除的患者中有50%患有骨性关节炎，而没有接受半月板切除的患者中这一比例为16%。半月板切除的合并优势比为3.54(95%可信区间为2.56-4.91)。这一荟萃分析的主要发现是，重建前交叉韧带后的膝关节骨关节炎的发生率低于人们通常认为的水平。然而，相关的半月板切除显著增加了发生OA.Level III的风险。
Although the occurrence of early osteoarthritis (OA) is commonly associated with a history of anterior cruciate ligament (ACL) reconstruction, its exact prevalence in these patients remains unknown. The goal of this study was to review the current literature on long-term radiographic outcome after autologous ACL reconstruction and subsequently perform a meta-analysis to obtain evidence-based prevalences of OA at a mean of 10 years after surgery. In addition, this report aimed at identifying the relationship between meniscal status and the occurrence of radiographic OA in the ACL reconstructed knee.A systematic review of the literature was performed in PubMed MEDLINE, EMBASE and Cochrane Library databases to identify all studies concerning radiographic outcome after autologous ACL reconstruction with a follow-up of minimum 10 years. Meta-analyses were performed to obtain the average prevalence of OA and the difference between patients with and without meniscectomy. Considered study estimates were the log-transformed odds and odds ratios, the latter expressing the effect of meniscectomy on OA.A total of 16 studies could be included for meta-analysis, accounting for 1554 ACL reconstructions performed between 1978 and 1997. Of these knees, 453 (28 %) showed radiological signs of osteoarthritis (IKDC grade C or D). Furthermore, 50 % of the patients with meniscectomy had osteoarthritis, compared with 16 % of the patients without meniscectomy. The combined odds ratio for meniscectomy equals 3.54 (95 % CI 2.56-4.91).The main finding of this meta-analysis is that the prevalence of radiographic knee OA after ACL reconstruction is lower than commonly perceived. However, associated meniscal resection dramatically increases the risk for developing OA.Level III.