Månsson Olle, Sernert Ninni, Ejerhed Lars, Kartus Jüri
Department of Orthopedics, NU Hospital Group, Uddevalla, Sweden; Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Orthopedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
Arthroscopy. 2016 Apr;32(4):615-23. doi: 10.1016/j.arthro.2015.08.039. Epub 2015 Nov 4.
The aims were to evaluate the results 10 to 20 years after anterior cruciate ligament (ACL) reconstruction performed in adolescents in terms of bone mineral density (BMD) in the calcanei using the dual-energy x-ray absorptiometry (DXA) technique, activity level, and quality of life.
A case-control study of adolescents who underwent ACL reconstruction between 1992 and 2002 was performed. The inclusion criterion was a unilateral ACL injury. The exclusion criteria were bilateral ACL injury, contralateral ACL reconstruction, posterior cruciate ligament injury, and previous or present fractures of either lower extremity. The BMD was measured in both calcanei using the DXA technique and compared with a control group of adult ACL-reconstructed patients and with a DXA reference database. The age of the control group was similar to that of the patient group at the time of BMD assessment, performed 60 months after reconstruction. Activity was measured with the Tegner activity scale. The EQ-5D was used to evaluate quality of life.
Thirty-two adolescents (11 boys and 21 girls), aged 12 to 16 years, with a symptomatic unilateral ACL rupture, underwent reconstruction at near skeletally mature age. Of these patients, 29 (91%) took part in the follow-up examination. The BMD values for the male patients were lower on the injured and non-injured sides (-15.2% [P = .02] and -11.8% [P = .05], respectively) compared with the control group. The values for the female patients were -0.8% (P = .84) and -2.2% (P = .69), respectively. Correspondingly, the BMD values for the male patients were lower on the injured and non-injured sides (-8.2% and -4.9%, respectively) compared with the male reference database. The BMD values for the female patients were higher on the injured and non-injured sides (4.1% and 4.3%, respectively) compared with the female reference database. In the control group, female patients had a significantly lower value for the Tegner activity scale preoperatively (median, 2.0; range, 0 to 5) than the female patients in the study group (median, 3.0; range, 2 to 8) (P = .006). In the study group, the Tegner activity scale at follow-up showed a significant correlation with the BMD on the injured side for male patients (ρ = 0.67, P = .03) but not on the non-injured side (ρ = 0.50, P = .14). In the control group, the Tegner activity scale at follow-up showed a significant correlation with the BMD on the non-injured side for female patients (ρ = 0.61, P = .03) but not on the injured side (ρ = 0.34, P = .25). The Tegner activity scale and EQ-5D showed no significant differences between the study groups.
In the long-term, the BMD in the calcanei of patients who were adolescents at the time of ACL reconstruction differed from that of a control group and a reference database. This study indicates that boys with an ACL injury and subsequent ACL reconstruction run a subsequent risk of a significantly lower BMD in their calcanei as adults and, consequently, an increased future fracture risk.
Level III, case-control study.
旨在评估青少年前交叉韧带（ACL）重建术后10至20年的结果，内容包括使用双能X线吸收法（DXA）技术测量跟骨的骨矿物质密度（BMD）、活动水平及生活质量。
对1992年至2002年间接受ACL重建的青少年进行病例对照研究。纳入标准为单侧ACL损伤。排除标准为双侧ACL损伤、对侧ACL重建、后交叉韧带损伤以及既往或当前存在的下肢骨折。使用DXA技术测量双侧跟骨的BMD，并与成年ACL重建患者对照组以及DXA参考数据库进行比较。对照组的年龄与重建后60个月进行BMD评估时的患者组年龄相似。使用Tegner活动量表测量活动情况。采用EQ - 5D评估生活质量。
32名年龄在12至16岁之间、有症状的单侧ACL断裂的青少年在接近骨骼成熟年龄时接受了重建手术。其中29名（91%）患者参与了随访检查。与对照组相比，男性患者受伤侧和未受伤侧的BMD值较低（分别为-15.2% [P = 0.02]和-11.8% [P = 0.05]）。女性患者的相应值分别为-0.8%（P = 0.84）和-2.2%（P = 0.69）。相应地，与男性参考数据库相比，男性患者受伤侧和未受伤侧的BMD值较低（分别为-8.²%和-4.9%）。与女性参考数据库相比，女性患者受伤侧和未受伤侧的BMD值较高（分别为4.1%和4.3%）。在对照组中，女性患者术前Tegner活动量表的值（中位数为2.0；范围为0至5）显著低于研究组中的女性患者（中位数为3.0；范围为2至8）（P = 0.006）。在研究组中，随访时Tegner活动量表显示男性患者受伤侧的BMD与之有显著相关性（ρ = 0.67，P = 0.03），但未受伤侧无相关性（ρ = 0.50，P = 0.14）。在对照组中，随访时Tegner活动量表显示女性患者未受伤侧的BMD与之有显著相关性（ρ = 0.61，P = 0.03），但受伤侧无相关性（ρ = 0.34，P = 0.25）。研究组之间Tegner活动量表和EQ - 5D无显著差异。
长期来看，ACL重建时为青少年的患者跟骨的BMD与对照组及参考数据库不同。本研究表明，ACL损伤并随后进行ACL重建的男孩成年后跟骨BMD显著降低，因此未来骨折风险增加。
Ⅲ级，病例对照研究。
