Shelbourne Knee Center, Indianapolis, IN 46202, USA.
Am J Sports Med. 2012 Jan;40(1):108-13. doi: 10.1177/0363546511423639. Epub 2011 Oct 11.
Meniscectomy and articular cartilage damage have been found to increase the prevalence of osteoarthritis after anterior cruciate ligament reconstruction, but the effect of knee range of motion has not been extensively studied.
The prevalence of osteoarthritis as observed on radiographs would be higher in patients who had abnormal knee range of motion compared with patients with normal knee motion, even when grouped for like meniscal or articular cartilage lesions.
Cohort study; Level of evidence, 3.
We prospectively followed patients at a minimum of 5 years after surgery. The constant goal of rehabilitation was to obtain full knee range of motion as quickly as possible after surgery and maintain it in the long term. Range of motion and radiographs were evaluated at the time of initial return to full activities (early follow-up) and final follow-up according to International Knee Documentation Committee (IKDC) objective criteria. A patient was considered to have normal range of motion if extension was within 2° of the opposite knee including hyperextension and knee flexion was within 5°. Radiograph findings were rated as abnormal if any signs of joint space narrowing, sclerosis, or osteophytes were present.
Follow-up was obtained for 780 patients at a mean of 10.5 ± 4.2 years after surgery. Of these, 539 had either normal or abnormal motion at both early and final follow-up. In 479 patients who had normal extension and flexion at both early and final follow-up, 188 (39%) had radiographic evidence of osteoarthritis versus 32 of 60 (53%) patients who had less than normal extension or flexion at early and final follow-up (P = .036). In subgroups of patients with like meniscal status, the prevalence of normal radiograph findings was significantly higher in patients with normal motion at final follow-up versus patients with motion deficits. Multivariate logistic regression analysis of categorical variables showed that abnormal knee flexion at early follow-up, abnormal knee extension at final follow-up, abnormal knee flexion at final follow-up, partial medial meniscectomy, and articular cartilage damage were significant factors related to the presence of osteoarthritis on radiographs. Abnormal knee extension at early follow-up showed a trend toward statistical significance (P = .0544). Logistic regression showed the odds of having osteoarthritis were 2 times more for patients with abnormal range of motion at final follow-up; these odds were similar for those with partial medial meniscectomy and articular cartilage damage.
The prevalence of osteoarthritis on radiographs in the long term after anterior cruciate ligament reconstruction is lower in patients who achieve and maintain normal knee motion, regardless of the status of the meniscus.
前交叉韧带重建术后，半月板切除术和关节软骨损伤被发现会增加骨关节炎的患病率，但膝关节活动范围的影响尚未得到广泛研究。
与膝关节运动正常的患者相比，膝关节活动范围异常的患者在放射照相上观察到的骨关节炎患病率更高，即使按照半月板或关节软骨病变进行分组也是如此。
队列研究；证据水平，3 级。
我们前瞻性随访患者，术后至少 5 年。康复的恒定目标是尽快获得术后膝关节的全范围活动度，并长期保持。根据国际膝关节文献委员会（IKDC）的客观标准，在初次恢复至完全活动（早期随访）和最终随访时评估活动范围和放射照相。如果患者的伸展度在与对侧膝关节相差 2°以内（包括过伸）且膝关节屈曲度在 5°以内，则认为其具有正常活动范围。如果存在关节间隙狭窄、硬化或骨赘等任何迹象，则认为放射照相结果异常。
在手术后平均 10.5±4.2 年时，对 780 名患者进行了随访。其中，539 名患者在早期和最终随访时均具有正常或异常运动。在 479 名早期和最终随访时均具有正常伸展和屈曲的患者中，188 名（39%）有放射照相证据表明存在骨关节炎，而 60 名（53%）早期和最终随访时伸展或屈曲度小于正常的患者中有 32 名（P=.036）。在具有相似半月板状况的患者亚组中，最终随访时运动正常的患者放射照相结果正常的比例明显高于运动受限的患者。对分类变量的多变量逻辑回归分析显示，早期随访时膝关节屈曲异常、最终随访时膝关节伸展异常、最终随访时膝关节屈曲异常、内侧半月板部分切除术和关节软骨损伤是与放射照相上存在骨关节炎相关的显著因素。早期随访时膝关节伸展异常有统计学意义的趋势（P=.0544）。逻辑回归显示，最终随访时运动范围异常的患者发生骨关节炎的几率是运动范围正常患者的 2 倍；对于内侧半月板部分切除术和关节软骨损伤的患者，这种几率相似。
在前交叉韧带重建术后的长期随访中，无论半月板状况如何，能够达到并保持正常膝关节运动的患者，其放射照相上的骨关节炎患病率较低。
