Does ACL Reconstruction Alter Natural History? A Systematic Literature Review of Long-Term Outcomes
Does ACL Reconstruction Alter Natural History? A Systematic Literature Review of Long-Term Outcomes
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DOI：
10.2106/jbjs.l.01713
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发表时间：
2014-02-19
影响因子：
5.3
通讯作者：
Bach, Bernard R., Jr.
中科院分区：
文献类型：
--
作者：
Chalmers, Peter N.;Mall, Nathan A.;Bach, Bernard R., Jr.
背景：前交叉韧带(ACL)损伤可导致胫股不稳、功能预后下降和退行性关节疾病。目前尚不清楚在长期的随访中，前交叉韧带重建是否会改变这一进展。方法：对前交叉韧带损伤的手术关节内重建术后和非手术治疗后的长期结果进行系统的文献回顾，以比较(1)体格检查的膝关节稳定性，(2)功能和基于患者的结果，(3)是否需要进一步的手术干预，以及(4)放射学结果。在应用选择标准后，确定了40个患者队列，平均术后随访13.9+/-3.1年。结果：手术组与非手术组在年龄、性别、体重指数、初发半月板损伤率等方面均无显著差异(均P>；0.05)。接受手术的患者对进一步手术的需求显著减少(12.4%比非手术组的24.9%，p=0.0176)，对后续半月板手术的需求更少(13.9%比29.4%，p=0.0017)，泰格纳评分下降更少(-1.9%比-3.1，p=0.0215)。轴移试验结果差异有统计学意义(25.5%为轴位阳性，46.6%为非手术组)，但差异无统计学意义(p=0.09)。在结果评分(Lysholm、国际膝关节文件委员会[IKDC]或最终的Tegner评分)或放射学上明显的退行性关节疾病发生率(均为p>；0.05)方面没有显著差异。结论：平均在损伤后13.9+/-3.1年，接受前交叉韧带重建术的患者随后半月板损伤较少，需要进一步手术的情况较少，根据Tegner评分衡量，活动水平明显改善。在Lysholm评分、IKDC评分或放射学明显的骨性关节炎的发展方面没有显著差异。
Background: Anterior cruciate ligament (ACL) injury can lead to tibiofemoral instability, decreased functional outcomes, and degenerative joint disease. It is unknown whether ACL reconstruction alters this progression at long-term follow-up.Methods: A systematic literature review of the long-term results (minimum follow-up, more than ten years) after operative intra-articular reconstruction of ACL injuries and after nonoperative management was performed to compare (1) knee stability on physical examination, (2) functional and patient-based outcomes, (3) the need for further surgical intervention, and (4) radiographic outcomes. After application of selection criteria, forty patient cohorts with a mean of 13.9 +/- 3.1 years of postoperative follow-up were identified. Twenty-seven cohorts containing 1585 patients had undergone reconstruction, and thirteen containing 685 patients had been treated nonoperatively.Results: Comparison of operative and nonoperative cohorts revealed no significant differences in age, sex, body mass index, or rate of initial meniscal injury (p > 0.05 for all). Operative cohorts had significantly less need for further surgery (12.4% compared with 24.9% for nonoperative, p = 0.0176), less need for subsequent meniscal surgery (13.9% compared with 29.4%, p = 0.0017), and less decline in the Tegner score (-1.9 compared with -3.1, p = 0.0215). A difference in pivot-shift test results was observed (25.5% pivot-positive compared with 46.6% for nonoperative) but did not reach significance (p = 0.09). No significant differences were seen in outcome scores (Lysholm, International Knee Documentation Committee [IKDC], or final Tegner scores) or the rate of radiographically evident degenerative joint disease (p > 0.05 for all).Conclusions: At a mean of 13.9 +/- 3.1 years after injury, the patients who underwent ACL reconstruction had fewer subsequent meniscal injuries, less need for further surgery, and significantly greater improvement in activity level as measured with the Tegner score. There were no significant differences in the Lysholm score, IKDC score, or development of radiographically evident osteoarthritis.