Changes in Knee Osteoarthritis, Symptoms, and Function After Anterior Cruciate Ligament Reconstruction A 20-Year Prospective Follow-up Study
Changes in Knee Osteoarthritis, Symptoms, and Function After Anterior Cruciate Ligament Reconstruction A 20-Year Prospective Follow-up Study
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DOI：
10.1177/0363546515626539
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发表时间：
2016-05-01
影响因子：
4.8
通讯作者：
Holm, Inger
中科院分区：
文献类型：
--
作者：
Risberg, May Arna;Oiestad, Britt Elin;Holm, Inger
背景：前交叉韧带重建 (ACLR) 后 15 年以上胫股骨 (TF) 和髌股骨 (PF) 骨关节炎 (OA) 的进展以及膝关节功能的变化尚不清楚。目的：检查 ACLR 后 15 至 20 年内膝关节 OA 的进展以及孤立性和复合性损伤的症状和功能变化。证据级别，2。方法：对总共 210 名 ACLR 受试者进行了前瞻性随访。在 15 年和 20 年的随访中，获取 X 光片并按照 Kellgren 和 Lawrence (K-L) 分级系统进行分类。通过膝关节损伤和骨关节炎结果评分 (KOOS) 以及等速股四头肌和腿筋肌肉力量测试来评估症状和功能。结果：有 168 名受试者 (80%) 返回进行 20 年随访，平均 (SD) 年龄为 45 +/- 9 岁，平均体重指数为 27 +/- 4，中位 Tegner 活动水平为 4 （范围，0-9）。 20 年随访时，影像学 TF 和 PF OA 的患病率分别为 42% 和 21%。与单纯 ACL 损伤的患者相比，患有 ACL 损伤和其他复合损伤的患者的放射学 TF OA 患病率显着更高 (P < .0001)。从 15 年到 20 年的随访，X 线 TF OA 增加了 13%（P = .001），PF OA 增加了 8%（P = .015）。 KOOS 量表中观察到膝关节症状和功能显着恶化 (P < .01)，但生活质量除外 (P = .14)，股四头肌力量和腿筋肌肉力量下降 (P < .0001)。结论：放射学 TF 和 PF OA 的患病率分别为 42% 和 21%。与单纯 ACL 损伤的受试者相比，合并损伤的受试者 TF OA 的患病率显着更高。大多数受试者在随访期间的 5 年内影像学表现稳定。注意到症状和功能在统计上显着恶化，但平均变化的临床重要性值得怀疑。
Background: Progression of tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA) and changes in knee function more than 15 years after anterior cruciate ligament reconstruction (ACLR) are not well understood.Purpose: To examine the progression of knee OA and changes in symptoms and function in isolated and combined injuries from 15 to 20 years after ACLR.Study Design: Cohort study; Level of evidence, 2.Methods: A total of 210 subjects with ACLR were prospectively followed. At the 15- and 20-year follow-ups, radiographs were obtained and classified by the Kellgren and Lawrence (K-L) grading system. Symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) as well as isokinetic quadriceps and hamstring muscle strength tests.Results: There were 168 subjects (80%) who returned for the 20-year follow-up, with a mean (SD) age of 45 +/- 9 years, mean body mass index of 27 +/- 4, and median Tegner activity level of 4 (range, 0-9). The prevalence of radiographic TF and PF OA at the 20-year follow-up was 42% and 21%, respectively. Patients with ACL injuries and other combined injuries had significantly higher prevalence of radiographic TF OA compared with those who had isolated ACL injury (P < .0001). There was a 13% increase in radiographic TF OA (P = .001) and an 8% increase in PF OA (P = .015) from the 15- to the 20-year follow-up. A significant deterioration in knee symptoms and function was observed on the KOOS subscales (P .01), with the exception of quality of life (P = .14), as well as a decrease in quadriceps muscle strength and hamstring muscle strength (P < .0001).Conclusion: The prevalence of radiographic TF and PF OA was 42% and 21%, respectively. A significantly higher prevalence of TF OA was found for subjects with combined injuries compared with those who had isolated ACL injury. The majority of the subjects were stable radiographically over the 5 years between follow-ups. A statistically significant deterioration in symptoms and function was noted, but the mean changes were of questionable clinical importance.