单束前交叉韧带重建术后患者报告结局的预测
Prediction of patient-reported outcome after single-bundle anterior cruciate ligament reconstruction.
作者信息
Kowalchuk Deborah A, Harner Christopher D, Fu Freddie H, Irrgang James J
机构信息
Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA.
出版信息
Arthroscopy. 2009 May;25(5):457-63. doi: 10.1016/j.arthro.2009.02.014.
PURPOSE
The purpose of this study was to identify preoperative and intraoperative factors that predict patient-oriented outcome as measured by the International Knee Documentation Committee (IKDC) Subjective Knee Form after anterior cruciate ligament (ACL) reconstruction.
METHODS
We identified 402 subjects who had undergone primary single-bundle arthroscopic ACL reconstruction at a mean follow-up of 6.3 years (range, 2 to 15 years). The IKDC Subjective Knee Form was used to measure patient-reported outcome and was dichotomized as above or below the patient-specific age- and gender-matched population mean. Potential predictor variables included subject demographics, activity level before surgery, previous meniscectomy, and surgical variables. Multivariate logistic regression analysis was performed to identify the best subset of predictors for determining the likelihood that the IKDC score was better than the age- and gender-matched population mean.
RESULTS
The dichotomized IKDC score was associated with body mass index (BMI), smoking status, education, previous medial meniscectomy, and medial chondrosis at the time of ACL reconstruction. The multivariate model containing only factors known before surgery included BMI and smoking status. Subjects with a BMI greater than 30 kg/m(2) had 0.35 times the odds of success as subjects with a normal BMI. Subjects who smoked had 0.36 times the odds of success as subjects who did not smoke. A model including medial chondrosis at the time of surgery had a slightly higher discriminatory power (area under the receiver operating characteristic curve, 0.65 v 0.61) and negative predictive value (71.4% v 60.0%) but similar positive predictive power (86.3% v 85.9%).
CONCLUSIONS
Lower patient-reported outcome after ACL reconstruction was strongly associated with obesity, smoking, and severe chondrosis at the time of surgery.
LEVEL OF EVIDENCE
Level III, prognostic case-control study.
目的
本研究旨在确定前交叉韧带（ACL）重建术后，通过国际膝关节文献委员会（IKDC）主观膝关节评分表所衡量的、以患者为导向的预后相关术前及术中因素。
方法
我们纳入了402例接受初次单束关节镜下ACL重建的患者，平均随访时间为6.3年（范围2至15年）。使用IKDC主观膝关节评分表来衡量患者报告的预后情况，并根据患者特定年龄和性别的匹配人群均值，将其分为高于或低于该均值两类。潜在的预测变量包括受试者人口统计学特征、术前活动水平、既往半月板切除术以及手术变量。进行多变量逻辑回归分析，以确定能最佳预测IKDC评分优于年龄和性别匹配人群均值可能性的预测因子子集。
结果
二分法的IKDC评分与体重指数（BMI）、吸烟状况、教育程度、既往内侧半月板切除术以及ACL重建时的内侧软骨病变相关。仅包含术前已知因素的多变量模型包括BMI和吸烟状况。BMI大于30 kg/m²的受试者成功的几率是BMI正常受试者的0.35倍。吸烟者成功的几率是不吸烟者的0.36倍。包含手术时内侧软骨病变的模型具有稍高的辨别力（受试者操作特征曲线下面积，0.65对0.61）和阴性预测值（71.4%对60.0%），但阳性预测值相似（86.3%对85.9%）。
结论
ACL重建术后患者报告的较低预后与肥胖、吸烟以及手术时的严重软骨病变密切相关。
证据等级
III级，预后性病例对照研究。
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