School of Health and Sport Sciences, The University of the Sunshine Coast, Queensland, Australia.
Am J Sports Med. 2010 Mar;38(3):455-63. doi: 10.1177/0363546509350914. Epub 2010 Jan 5.
The incidence of osteoarthritis after anterior cruciate ligament reconstruction is disturbingly high, with reports of nearly 50% of patients developing mild to moderate osteoarthritis 6 years after surgery. Few studies have assessed the factors involved in the development of osteoarthritis.
The following 10 factors will be found to be predictive of osteoarthritis: meniscectomy, chondral damage, patellar tendon grafting, age at surgery, time delay between injury and surgery, type and intensity of postsurgery sport, quadriceps strength, hamstring strength, quadriceps-to-hamstring strength ratio, and residual joint laxity.
Cohort study (prognosis); Level of evidence, 1.
Fifty-six subjects with anterior cruciate ligament reconstruction were followed for 6 years after surgery. Assessment included KT-1000 arthrometer testing, isokinetic strength testing, a return-to-sport questionnaire, and a radiograph assessment. A discriminant analysis was performed to assess which of the 10 factors could discriminate between those patients who developed tibiofemoral and patellofemoral osteoarthritis and those who did not.
Five factors were found to be predictive of tibiofemoral osteoarthritis. Meniscectomy (r = .72) and chondral damage (r = .41) were the strongest discriminators, followed by patellar tendon grafting (r = .37) (chi(2) [7, n = 56] = 25.48; P = .001). Weak quadriceps (r = .39) and low quadriceps-to-hamstring strength ratios (r = .6) were very close discriminators (chi(2) [8, n = 42] = 15.02; P = .059). For patellofemoral osteoarthritis, meniscectomy (r = .45), chondral damage (r = .75), and age at surgery (r = .65) were predictors or close predictors (chi(2) [7, n = 54] = 13.30; P = .065).
As not all 10 factors studied were predictive of osteoarthritis, the hypothesis was only partially proven. Preventing further meniscal and chondral damage in patients with anterior cruciate ligament deficiency is critical. Grafting using the hamstring tendons and restoration of quadriceps-to-hamstring strength balance are associated with less osteoarthritis.
前交叉韧带重建术后骨关节炎的发病率高得令人不安，术后 6 年有近 50%的患者出现轻度至中度骨关节炎。很少有研究评估与骨关节炎发展相关的因素。
以下 10 个因素将被发现可预测骨关节炎：半月板切除术、软骨损伤、髌腱移植物、手术时的年龄、损伤与手术之间的时间延迟、术后运动的类型和强度、股四头肌力量、腘绳肌力量、股四头肌与腘绳肌力量比以及关节残余松弛度。
队列研究（预后）；证据水平，1 级。
对 56 例前交叉韧带重建术后患者进行了 6 年的随访。评估包括 KT-1000 关节测量仪测试、等速肌力测试、重返运动问卷和 X 线评估。进行判别分析以评估 10 个因素中的哪些因素可以区分发生胫股和髌股骨关节炎的患者与未发生骨关节炎的患者。
发现 5 个因素可预测胫股骨关节炎。半月板切除术（r =.72）和软骨损伤（r =.41）是最强的鉴别因素，其次是髌腱移植物（r =.37）（χ2[7，n = 56] = 25.48；P =.001）。股四头肌力量弱（r =.39）和股四头肌与腘绳肌力量比低（r =.6）非常接近鉴别因素（χ2[8，n = 42] = 15.02；P =.059）。对于髌股骨关节炎，半月板切除术（r =.45）、软骨损伤（r =.75）和手术时的年龄（r =.65）是预测因素或接近预测因素（χ2[7，n = 54] = 13.30；P =.065）。
由于并非所有 10 个研究因素都可预测骨关节炎，因此该假设仅得到部分证实。防止前交叉韧带缺陷患者的半月板和软骨进一步损伤至关重要。使用腘绳肌腱进行移植物和恢复股四头肌与腘绳肌力量平衡与较少的骨关节炎相关。
