Age, gender, quadriceps strength and hop test performance are the most important factors affecting the achievement of a patient-acceptable symptom state after ACL reconstruction
Age, gender, quadriceps strength and hop test performance are the most important factors affecting the achievement of a patient-acceptable symptom state after ACL reconstruction
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DOI：
10.1007/s00167-019-05576-2
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发表时间：
2020-02-01
影响因子：
3.8
通讯作者：
Stalman, Anders
中科院分区：
文献类型：
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作者：
Cristiani, Riccardo;Mikkelsen, Christina;Stalman, Anders
目的在一个大型队列中评估初次前交叉韧带重建（ACLR）后2年达到可接受症状状态的患者百分比，并确定影响其实现的因素。方法在我们的临床登记处确定了2005年至2015年在瑞典斯德哥尔摩Capio Artro诊所接受初次ACLR的患者。纳入了在2年随访时完成膝关节损伤和骨关节炎结局评分（KOOS）的患者。主要结局是每个KOOS子量表达到患者可接受的症状状态（PASS）。多变量逻辑回归分析用于确定患者年龄、性别、从损伤到手术的时间、损伤前Tegner活动水平、移植物类型、软骨损伤，存在内侧半月板（MM）或外侧半月板（LM）切除或修复以及6个月对称性恢复（肢体对称指数[LSI]>= 90%）等速股四头肌或腘绳肌力量和单腿跳跃测试表现是与每个KOOS子量表获得PASS相关的因素。结果共纳入2335例原发性ACLR。超过60%的患者报告了5个KOOS分量表中4个的PASS。年龄>= 30岁和6个月等速股四头肌力量的LSI>= 90%增加了在所有KOOS分量表中获得PASS的几率。女性降低了疼痛（OR 0.76; 95% CI 0.62 - 0.94; P = 0.01）、日常生活活动（ADL）（OR 0.79; 95% CI 0.64 - 0.97; P = 0.02）和运动和娱乐（OR 0.72; 95% CI 0.58 - 0.89; P = 0.003）子量表获得PASS的几率。MM修复术的存在降低了疼痛（OR 0.59; 95% CI 0.36 - 0.96; P = 0.03）子量表通过的几率。腘绳肌肌腱（HT）自体移植物而非骨-髌腱-骨（BPTB）自体移植物显示在运动和娱乐子量表上获得PASS的几率增加（OR 2.02; 95% CI 1.31 - 3.10; P = 0.001），而软骨损伤显示获得PASS的几率降低（OR 0.73; 95% CI 0.55 - 0.97; P = 0.03）。6个月单腿跳跃测试表现的LSI>= 90%增加了ADL通过的几率（OR 1.37; 95% CI 1.09 - 1.71; P = 0.005），运动和娱乐（OR 1.40; 95% CI 1.11 - 1.77; P = 0.004）和生活质量（OR 1.28; 95% CI 1.00 - 1.63; P = 0.04）子量表。结论原发性ACLR后2年，超过60%的患者报告了5个KOOS分量表中4个的可接受症状状态。年龄>= 30岁和女性是不可改变的因素，分别持续增加和减少获得PASS的几率。对称的6个月等速股四头肌力量和单腿跳跃测试表现是可改变的因素，这些因素持续增加了初次ACLR后2年获得PASS的机会。
Purpose To assess the percentage of patients achieving an acceptable symptom state 2 years after primary anterior cruciate ligament reconstruction (ACLR) and to identify factors affecting its achievement, in a large cohort. Methods Patients who underwent primary ACLR at Capio Artro Clinic, Stockholm, Sweden, from 2005 to 2015, were identified in our clinic registry. Patients who had completed the Knee injury and Osteoarthritis Outcome Score (KOOS) at the 2-year follow-up were included. The primary outcome was the achievement of a patient-acceptable symptom state (PASS) for each KOOS subscale. A multivariate logistic regression analysis was used to determine whether patient age, gender, time from injury to surgery, pre-injury Tegner activity level, graft type, cartilage injury, the presence of medial meniscus (MM) or lateral meniscus (LM) resection or repair and the recovery of 6-month symmetrical (limb symmetry index [LSI] of >= 90%) isokinetic quadriceps or hamstring strength and single-leg-hop test performance were factors associated with the achievement of a PASS for each KOOS subscale. Results A total of 2335 primary ACLRs were included. More than 60% of the patients reported a PASS on four of the five KOOS subscales. Age >= 30 years and an LSI of >= 90% for 6-month isokinetic quadriceps strength increased the odds of achieving a PASS across all KOOS subscales. Female gender reduced the odds of achieving a PASS on the Pain (OR 0.76; 95% CI 0.62-0.94; P = 0.01), activities of daily living (ADL) (OR 0.79; 95% CI 0.64-0.97; P = 0.02) and sport and recreation (OR 0.72; 95% CI 0.58-0.89; P = 0.003) subscales. The presence of an MM repair reduced the odds of achieving a PASS on the Pain (OR 0.59; 95% CI 0.36-0.96; P = 0.03) subscale. Hamstring tendon (HT) autograft rather than bone-patellar tendon-bone (BPTB) autograft showed increased odds (OR 2.02; 95% CI 1.31-3.10; P = 0.001), whereas a cartilage injury showed reduced odds (OR 0.73; 95% CI 0.55-0.97; P = 0.03) of achieving a PASS on the sport and recreation subscale. An LSI of >= 90% for 6-month single-leg-hop test performance increased the odds of achieving a PASS on the ADL (OR 1.37; 95% CI 1.09-1.71; P = 0.005), Sport and Recreation (OR 1.40; 95% CI 1.11-1.77; P = 0.004), and quality of life (OR 1.28; 95% CI 1.00-1.63; P = 0.04) subscales. Conclusion More than 60% of the patients reported an acceptable symptom state on four of the five KOOS subscales 2 years after primary ACLR. Age >= 30 years and female gender were the non-modifiable factors that consistently increased and reduced, respectively, the odds of achieving a PASS. A symmetrical 6-month isokinetic quadriceps strength and single-leg-hop test performance were the modifiable factors that consistently increased the opportunity of achieving a PASS 2 years after primary ACLR.