Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction
Post-traumatic osteoarthritis diagnosed within 5 years following ACL reconstruction
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DOI：
10.1007/s00167-019-05461-y
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发表时间：
2020-03-01
影响因子：
3.8
通讯作者：
Hart, Joseph M.
中科院分区：
文献类型：
--
作者：
Bodkin, Stephan G.;Werner, Brian C.;Hart, Joseph M.
目的是在一个大型的国家数据库中计算前交叉韧带重建（ACLR）后个体骨关节炎的发病率，并检查与骨关节炎发展相关的危险因素。方法查询市售保险数据库，以确定ACLR患者膝关节OA的新诊断。计算ACLR患者膝关节OA诊断的累积发生率，并按重建时间分层。使用逻辑回归计算优势比，以描述与新OA诊断相关的因素，包括年龄、性别、BMI、半月板受累、骨软骨移植使用和烟草使用。结果共发现10565例ACLR患者未诊断为OA，其中517例在ACL重建5年后新诊断为膝关节OA。按随访时间点分层，6个月内新发OA的发生率为2.3%；1年随访期间为4.1%；2年内随访6.2%，3年内随访8.4%；4年内随访率为10.4%；5年内的随访率为12.3%。新发OA诊断的危险因素为年龄（OR 2.44, P < 0.001）、性别（OR 1.2, P = 0.002）、肥胖（OR 1.4, P < 0.001）、吸烟（OR 1.3, P = 0.001）和半月板受损伤（OR 1.2, P = 0.005）。结论：ACLR术后5年内就诊的患者中约有12%被诊断为OA。与ACLR术后5年内诊断为PTOA风险增加相关的人口统计学因素有年龄、性别、BMI、吸烟和伴随的半月板手术。临床医生应该认识到这些风险因素，以制定患者的风险概况，共同目标是实现ACLR后的最佳长期预后。
Purpose The purpose was to calculate the incidence of osteoarthritis in individuals following Anterior Cruciate Ligament Reconstruction (ACLR) in a large, national database and to examine the risk factors associated with OA development. Methods A commercially available insurance database was queried to identify new diagnoses of knee OA in patients with ACLR. The cumulative incidence of knee OA diagnoses in patients after ACLR was calculated and stratified by time from reconstruction. Odds ratios were calculated using logistic regression to describe factors associated with a new OA diagnosis including age, sex, BMI, meniscus involvement, osteochondral graft use, and tobacco use. Results A total of 10,565 patients with ACLR were identified that did not have an existing diagnosis of OA, 517 of which had a documented new diagnosis of knee OA 5 years after ACL reconstruction. When stratified by follow-up time points, the incidence of a new OA diagnosis within 6 months was 2.3%; within a 1-year follow-up was 4.1%; within 2 years, follow-up was 6.2%, within 3 years, follow-up was 8.4%; within 4 years, follow-up was 10.4%; and within 5 years, follow-up was 12.3%. Risk factors for new OA diagnoses were age (OR 2.44, P < 0.001), sex (OR 1.2, P = 0.002), obesity (OR 1.4, P < 0.001), tobacco use (OR = 1.3, P = 0.001), and meniscal involvement (OR 1.2, P = 0.005). Conclusion Approximately 12% of patients presenting within 5 years following ACLR are diagnosed with OA. Demographic factors associated with an increased risk of a diagnosis of PTOA within 5 years after ACLR are age, sex, BMI, tobacco use, and concomitant meniscal surgery. Clinicians should be cognizant of these risk factors to develop risk profiles in patients with the common goal to achieve optimal long-term outcomes after ACLR.