Spindler Kurt P, Warren Todd A, Callison J Claiborne, Secic Michelle, Fleisch Sheryl B, Wright Rick W
Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, Tennessee 37232-8774, USA.
J Bone Joint Surg Am. 2005 Aug;87(8):1673-9. doi: 10.2106/JBJS.D.01842.
We are not aware of any previous studies in which independent measurements of function with validated outcome questionnaires such as the Knee Injury and Osteoarthritis Outcome Score and the International Knee Documentation Committee score were evaluated five years after reconstruction of the anterior cruciate ligament. We hypothesized that patient demographics, mechanism of injury, and intra-articular injuries and their treatment are factors associated with function five years after reconstruction of the anterior cruciate ligament.
A consecutive series of unilateral, arthroscopically assisted primary reconstructions of the anterior cruciate ligament performed by one surgeon using a patellar tendon graft was evaluated. Data on patient demographics, injury variables, and intra-articular lesions noted at the time of surgery were collected prospectively. Multivariable regression analysis was used to identify independent predictors of outcomes as measured with five questionnaires.
Sixty-nine percent (217) of 314 knees with a reconstruction of the anterior cruciate ligament were followed for an average of 5.4 years. The average age at the time of the operation was twenty-seven years. Independent predictors of a worse outcome, which was measured with the overall Knee Injury and Osteoarthritis Outcome Score, the International Knee Documentation Committee score, the Lysholm score, and the Western Ontario and McMaster Universities Osteoarthritis Index score, included the patient's recollection of hearing or feeling a pop at the time of the injury, a weight gain of >15 lb (6.8 kg), and no change in educational level since the surgery. There was a lack of association between the outcome and either the occurrence or the form of treatment of a meniscal tear or chondromalacia of the articular cartilage.
To our knowledge, we performed the first prospective cohort study to evaluate the prognosis following reconstruction of the anterior cruciate ligament by identifying significant associations between multiple variables and clinical outcomes as measured with validated questionnaires. The clinician can counsel patients about the intermediate-term functional outcomes of reconstructions of the anterior cruciate ligament on the basis of these findings. Suggestions regarding weight control and future education may improve intermediate-term outcomes.
我们不知道此前有任何研究在重建前交叉韧带五年后，使用诸如膝关节损伤和骨关节炎疗效评分（Knee Injury and Osteoarthritis Outcome Score）以及国际膝关节文献委员会评分（International Knee Documentation Committee score）等经过验证的结局问卷对功能进行独立测量。我们假设患者的人口统计学特征、损伤机制、关节内损伤及其治疗是与重建前交叉韧带五年后的功能相关的因素。
对由一名外科医生使用髌腱移植物进行的一系列连续的单侧关节镜辅助下前交叉韧带初次重建进行评估。前瞻性收集手术时记录的患者人口统计学数据、损伤变量和关节内病变情况。使用多变量回归分析来确定用五份问卷测量的结局的独立预测因素。
314例接受前交叉韧带重建的膝关节中有69%（217例）平均随访了5.4年。手术时的平均年龄为27岁。用膝关节损伤和骨关节炎总体疗效评分、国际膝关节文献委员会评分、Lysholm评分以及西安大略和麦克马斯特大学骨关节炎指数评分测量，结局较差的独立预测因素包括患者回忆受伤时听到或感觉到“啪”的一声、体重增加>15磅（6.8千克）以及自手术以来教育水平无变化。半月板撕裂或关节软骨软化的发生或治疗形式与结局之间均无关联。
据我们所知，我们进行了第一项前瞻性队列研究，通过确定多个变量与用经过验证的问卷测量的临床结局之间的显著关联来评估前交叉韧带重建后的预后。临床医生可根据这些发现就前交叉韧带重建的中期功能结局向患者提供咨询。关于体重控制和未来教育的建议可能会改善中期结局。
