Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort.
Risk Factors and Predictors of Subsequent ACL Injury in Either Knee After ACL Reconstruction: Prospective Analysis of 2488 Primary ACL Reconstructions From the MOON Cohort.
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DOI：
10.1177/0363546515578836
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发表时间：
2015-07
期刊：
影响因子：
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通讯作者：
Spindler KP
中科院分区：
文献类型：
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作者：
Kaeding CC;Pedroza AD;Reinke EK;Huston LJ;MOON Consortium;Spindler KP
前交叉韧带（ACL）再损伤会导致较差的结果，并增加创伤后骨关节炎的风险。目的探讨原发性ACL重建（ACLR）后同侧和对侧ACL撕裂的危险因素。队列研究;证据水平，3。来自多中心骨科结果网络（MOON）的数据是一项前瞻性纵向队列研究，用于确定ACL复发的危险因素。研究对象为原发性ACLR，无对侧膝关节手术史，随访时间至少为2年。评估年龄、性别、Marx活动评分、移植物类型、外侧半月板撕裂、内侧半月板撕裂、指数损伤时进行的运动和手术设施，以确定其对同侧后撕裂和对侧前交叉韧带撕裂的影响。2683名平均年龄为27±11岁的受试者（1498名男性，56%）符合所有研究纳入/排除标准。总的来说，4.4%的同侧移植物撕裂和3.5%的对侧前交叉韧带撕裂。与自体骨-髌腱-骨（BTB）移植相比，同种异体移植的同侧再撕率高出5.2倍（p<0.01）；自体BTB与自体腘绳肌移植的再撕率无显著差异（p=0.12）。年龄每增加1分，同侧前交叉韧带再撕裂的几率降低0.09 (p<0.01)，马克思评分每增加1分，同侧前交叉韧带再撕裂的几率增加0.11 （p<0.01）。性别、吸烟状况、参加体育运动、内侧或外侧半月板撕裂或联合体部位对其发生率无显著影响（p < 0.05）。年龄每增加1分，对侧ACL撕裂的发生率降低0.04 (p=0.04)，马克思评分每增加1分，对侧ACL撕裂的发生率降低0.12 (p<0.01)；性别、吸烟状况、运动、移植物类型、内侧半月板撕裂和外侧半月板撕裂之间的差异无统计学意义（p < 0.05）。较年轻的年龄、较高的活动水平和同种异体移植物类型是同侧移植物失败几率增加的预测因素。活动量大、年龄小是对侧前交叉韧带撕裂的危险因素。
Anterior cruciate ligament (ACL) re-injury results in worse outcomes and increases risk of post-traumatic osteoarthritis. To identify the risk factors for both ipsilateral and contralateral ACL tears after primary ACL reconstruction (ACLR). Cohort study; Level of evidence, 3. Data from the Multicenter Orthopaedic Outcomes Network (MOON), a prospective longitudinal cohort, were used to identify risk factors for ACL retear. Subjects with primary ACLR, no history of contralateral knee surgery, and a minimum of 2-year follow-up data were included. Age, sex, Marx activity score, graft type, lateral meniscus tear, medial meniscus tear, sport played at index injury, and surgical facility were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. A total of 2683 subjects with average age of 27 ± 11 years (1498 men; 56%) met all study inclusion/exclusion criteria. Overall there were 4.4% ipsilateral graft tears and 3.5% contralateral ACL tears. The odds of ipsilateral retear were 5.2 times greater for an allograft (p<0.01) compared with a bone-patellar tendon-bone (BTB) autograft; the odds of retear were not significantly different between BTB autograft and hamstring autograft (p=0.12). The odds of an ipsilateral ACL retear decreased by 0.09 for every yearly increase in age (p<0.01) and increased by 0.11 for every increased point on the Marx score (p< 0.01). The odds were not significantly influenced by sex, smoking status, sport played, medial or lateral meniscus tear, or consortium site (p>0.05). The odds of a contralateral ACL tear decreased by 0.04 for every yearly increase in age (p=0.04) and increased by 0.12 for every increased point on the Marx score (p<0.01); these odds were not significantly different between sex, smoking status, sport played, graft type, medial meniscal tear, and lateral meniscal tear (p>0.05). Younger age, higher activity level, and allograft graft type were predictors of increased odds of ipsilateral graft failure. Higher activity and younger age were found to be risk factors in contralateral ACL tears.