Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
Department of Orthopaedic Surgery, Erasmus MC, University Medical Centre Rotterdam, The Netherlands Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
Br J Sports Med. 2015 Aug;49(15):975-83. doi: 10.1136/bjsports-2013-093258. Epub 2015 Mar 30.
Anterior cruciate ligament (ACL) injury is an important risk factor for development of knee osteoarthritis (OA). To identify those ACL injured patients at increased risk for knee OA, it is necessary to understand risk factors for OA.
To summarise the evidence for determinants of (1) tibiofemoral OA and (2) patellofemoral OA in ACL injured patients.
MEDLINE, EMBASE, Web of Science and CINAHL databases were searched up to 20 December 2013. Additionally, reference lists of eligible studies were manually and independently screened by two reviewers. 2348 studies were assessed for the following main inclusion criteria: ≥20 patients; ACL injured patients treated operatively or non-operatively; reporting OA as outcome; description of relationship between OA outcome and determinants; and a follow-up period ≥2 years. Two reviewers extracted the data, assessed the risk of bias and performed a best-evidence synthesis.
Sixty-four publications were included and assessed for quality. Two studies were classified as low risk of bias. Medial meniscal injury/meniscectomy showed moderate evidence for influencing OA development (tibiofemoral OA and compartment unspecified). Lateral meniscal injury/meniscectomy showed moderate evidence for no relationship (compartment unspecified), as did time between injury and reconstruction (tibiofemoral and patellofemoral OA).
Medial meniscal injury/meniscectomy after ACL rupture increased the risk of OA development. In contrast, it seems that lateral meniscal injury/meniscectomy has no relationship with OA development. Our results suggest that time between injury and reconstruction does not influence patellofemoral and tibiofemoral OA development. Many determinants showed conflicting and limited evidence and no determinant showed strong evidence.
前交叉韧带（ACL）损伤是膝关节骨关节炎（OA）发展的重要危险因素。为了确定那些ACL 损伤患者患 OA 的风险增加，有必要了解 OA 的危险因素。
总结 ACL 损伤患者（1）胫股关节 OA 和（2）髌股关节 OA 的决定因素的证据。
检索 MEDLINE、EMBASE、Web of Science 和 CINAHL 数据库，检索截至 2013 年 12 月 20 日。此外，两名审查员还分别独立地手动筛选了合格研究的参考文献列表。评估了 2348 项研究，其主要纳入标准为：≥20 例患者；ACL 损伤患者经手术或非手术治疗；将 OA 作为结局报告；描述 OA 结局与决定因素之间的关系；以及随访期≥2 年。两名审查员提取数据、评估偏倚风险并进行最佳证据综合。
纳入了 64 篇文献并进行了质量评估。有两项研究被归类为低偏倚风险。内侧半月板损伤/半月板切除术显示对 OA 发展有中度影响（胫股关节和未指定关节室）。外侧半月板损伤/半月板切除术显示无关系（未指定关节室），受伤与重建之间的时间也是如此（髌股关节和胫股关节 OA）。
ACL 断裂后内侧半月板损伤/半月板切除术增加了 OA 发展的风险。相比之下，外侧半月板损伤/半月板切除术似乎与 OA 发展无关。我们的结果表明，受伤与重建之间的时间不会影响髌股关节和胫股关节 OA 的发展。许多决定因素的证据存在矛盾和有限，没有决定因素显示出强有力的证据。
