Ligament Injury, Reconstruction and Osteoarthritis.
Ligament Injury, Reconstruction and Osteoarthritis.
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DOI：
10.1097/01.bco.0000176423.07865.d2
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发表时间：
2005-10-01
期刊：
影响因子：
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通讯作者：
Fadale, Paul D
中科院分区：
文献类型：
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作者：
Fleming, Braden C;Hulstyn, Michael J;Fadale, Paul D
综述目的：对近期有关韧带损伤及其治疗后引发和加速骨关节炎进展的因素的文献进行综述。
近期发现：韧带损伤的关节发生骨关节炎的风险较高。目前的保守治疗（如康复治疗）和手术治疗（如重建手术）似乎都不能减少韧带损伤后的骨关节炎。骨关节炎的严重程度似乎并不取决于受影响的是哪个关节，也不取决于关节内其他组织是否受损。机械不稳定可能是韧带损伤患者发生骨关节炎的始动因素。
总结：骨关节炎的发病机制始于损伤导致关节不稳定。不稳定增加了关节面之间的滑动，降低了肌肉的效率，这些因素改变了关节的接触力学。软骨和下方骨骼的负荷分布被打乱，导致磨损和剪切力增加，最终导致骨软骨退变。这一力学过程的催化剂是损伤引发并在愈合过程中持续存在的炎症反应。相反，炎症可能是发病的原因，而力学因素则加速了疾病的进展。韧带损伤后导致骨关节炎的机制尚未完全明确。更好地理解这些机制应该会带来手术、药物和组织工程等替代治疗方案，从而有可能消除这些患者的骨关节炎。各个方面都在取得进展。考虑到尽管有目前的治疗方案，骨关节炎仍有可能发生，最佳的解决方案可能是预防。
PURPOSE OF REVIEW: The recent literature on the factors that initiate and accelerate the progression of osteoarthritis following ligament injuries and their treatment is reviewed. RECENT FINDINGS: The ligament-injured joint is at high risk for osteoarthritis. Current conservative (e.g. rehabilitation) and surgical (e.g. reconstruction) treatment options appear not to reduce osteoarthritis following ligament injury. The extent of osteoarthritis does not appear dependent on which joint is affected, or the presence of damage to other tissues within the joint. Mechanical instability is the likely initiator of osteoarthritis in the ligament-injured patient. SUMMARY: The mechanism osteoarthritis begins with the injury rendering the joint unstable. The instability increases the sliding between the joint surfaces and reduces the efficiency of the muscles, factors that alter joint contact mechanics. The load distribution in the cartilage and underlying bone is disrupted, causing wear and increasing shear, which eventually leads to the osteochondral degeneration. The catalyst to the mechanical process is the inflammation response induced by the injury and sustained during healing. In contrast, the inflammation could be responsible for onset, while the mechanical factors accelerate progression. The mechanisms leading to osteoarthritis following ligament injury have not been fully established. A better understanding of these mechanisms should lead to alternative surgical, drug, and tissue-engineering treatment options, which could eliminate osteoarthritis in these patients. Progress is being made on all fronts. Considering that osteoarthritis is likely to occur despite current treatment options, the best solution may be prevention.