Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial.
Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial.
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DOI：
10.1136/bmj.f232
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发表时间：
2013-01-24
期刊：
影响因子：
--
通讯作者：
Lohmander LS
中科院分区：
文献类型：
--
作者：
Frobell RB;Roos HP;Roos EM;Roemer FW;Ranstam J;Lohmander LS
目的比较青年活动期急性前交叉韧带(ACL)撕裂患者中期(5年)康复加早期前交叉韧带重建术与康复加选择性延迟前交叉韧带重建术的疗效。设计前瞻性随机对照试验的延长随访研究。在瑞典的两家医院设置骨科。受试者121名年轻、活跃的成年人(平均年龄26岁)，患有急性前交叉韧带损伤的先前未受伤的膝关节。一名患者失去了五年的随访期。干预所有患者均接受类似的结构化康复治疗。除康复外，62名患者被分配到早期前交叉韧带重建，59名患者被分配到需要时进行延迟前交叉韧带重建的选项。主要结果指标主要结果是膝关节损伤和骨关节炎结果评分(KOOS4)的五个子量表中的四个子量表的平均值从基线到五年的变化。其他结果包括5年后的KOOS4绝对评分、所有5个Koos子量表评分、SF-36、Tegner活动量表、半月板手术和放射学骨性关节炎。结果选择延迟重建前交叉韧带的患者中有30例(51%)前交叉韧带重建延迟(7例2~5年)。从基线到5年，康复+早期前交叉韧带重建组和康复+选择性延迟重建组的KOOS-4评分的平均变化分别为42.9分和44.9分(组间差异2.0分，95%可信区间−8.5~4.5；经基线评分调整后P=0.54)。治疗5年后，两组间KOS4评分(P=0.45)、Koos各分量表评分(P≥0.12)、SF-36评分(P≥0.34)、Tegner活动度评分(P=0.74)及膝关节放射学骨性关节炎发生率(P=0.17)均无显著差异。在接受半月板手术的膝关节数量(P=0.48)或半月板手术的时间-事件分析(P=0.77)方面，两组之间没有差异。根据实际接受的治疗进行分析时，结果是相似的。结论在这项高质量的随机对照试验中，5年后康复加早期重建前交叉韧带的效果并不比早期康复加后期重建前交叉韧带的策略好。早期或晚期手术重建的膝关节与仅接受康复治疗的膝关节结果并无差异。这些结果应该鼓励临床医生和年轻活跃的成年患者考虑将康复作为急性前交叉韧带撕裂后的主要治疗选择。试验登记当前对照试验ISRCTN84752559。
Objective To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL reconstruction. Design Extended follow-up of prospective randomised controlled trial. Setting Orthopaedic departments at two hospitals in Sweden. Participants 121 young, active adults (mean age 26 years) with acute ACL injury to a previously uninjured knee. One patient was lost to five year follow-up. Intervention All patients received similar structured rehabilitation. In addition to rehabilitation, 62 patients were assigned to early ACL reconstruction and 59 were assigned to the option of having a delayed ACL reconstruction if needed. Main outcome measure The main outcome was the change from baseline to five years in the mean value of four of the five subscales of the knee injury and osteoarthritis outcome score (KOOS4). Other outcomes included the absolute KOOS4 score, all five KOOS subscale scores, SF-36, Tegner activity scale, meniscal surgery, and radiographic osteoarthritis at five years. Results Thirty (51%) patients assigned to optional delayed ACL reconstruction had delayed ACL reconstruction (seven between two and five years). The mean change in KOOS4 score from baseline to five years was 42.9 points for those assigned to rehabilitation plus early ACL reconstruction and 44.9 for those assigned to rehabilitation plus optional delayed reconstruction (between group difference 2.0 points, 95% confidence interval −8.5 to 4.5; P=0.54 after adjustment for baseline score). At five years, no significant between group differences were seen in KOOS4 (P=0.45), any of the KOOS subscales (P≥0.12), SF-36 (P≥0.34), Tegner activity scale (P=0.74), or incident radiographic osteoarthritis of the index knee (P=0.17). No between group differences were seen in the number of knees having meniscus surgery (P=0.48) or in a time to event analysis of the proportion of meniscuses operated on (P=0.77). The results were similar when analysed by treatment actually received. Conclusion In this first high quality randomised controlled trial with minimal loss to follow-up, a strategy of rehabilitation plus early ACL reconstruction did not provide better results at five years than a strategy of initial rehabilitation with the option of having a later ACL reconstruction. Results did not differ between knees surgically reconstructed early or late and those treated with rehabilitation alone. These results should encourage clinicians and young active adult patients to consider rehabilitation as a primary treatment option after an acute ACL tear. Trial registration Current Controlled Trials ISRCTN84752559.
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影响因子：
27.4
作者：
Roos, E. M.;Bremander, A. B.;Lohmander, L. S.
通讯作者：
Lohmander, L. S.
DOI：
10.1111/j.1600-0838.2008.00816.x
发表时间：
2009-06-01
影响因子：
4.1
作者：
Moksnes, H.;Risberg, M. A.
通讯作者：
Risberg, M. A.
影响因子：
158.5
作者：
Frobell, Richard B.;Roos, Ewa M.;Lohmander, L. Stefan
通讯作者：
Lohmander, L. Stefan
影响因子：
--
作者：
Englund, Martin;Guermazi, Ali;Roemer, Frank W.;Aliabadi, Piran;Yang, Mei;Lewis, Cora E.;Torner, James;Nevitt, Michael C.;Sack, Burton;Felson, David T.
通讯作者：
Felson, David T.
DOI：
10.1111/j.1600-0838.2006.00547.x
发表时间：
2007-06-01
影响因子：
4.1
作者：
Meunier, A.;Odensten, M.;Good, L.
通讯作者：
Good, L.