Risberg May Arna, Oiestad Britt Elin, Gunderson Ragnhild, Aune Arne Kristian, Engebretsen Lars, Culvenor Adam, Holm Inger
Norwegian Research Center for Active Rehabilitation, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
Norwegian Research Center for Active Rehabilitation, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Oslo and Akerhus University College of Applied Sciences, Institute of Physiotherapy, Oslo, Norway.
Am J Sports Med. 2016 May;44(5):1215-24. doi: 10.1177/0363546515626539. Epub 2016 Feb 24.
Progression of tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA) and changes in knee function more than 15 years after anterior cruciate ligament reconstruction (ACLR) are not well understood.
To examine the progression of knee OA and changes in symptoms and function in isolated and combined injuries from 15 to 20 years after ACLR.
Cohort study; Level of evidence, 2.
A total of 210 subjects with ACLR were prospectively followed. At the 15- and 20-year follow-ups, radiographs were obtained and classified by the Kellgren and Lawrence (K-L) grading system. Symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) as well as isokinetic quadriceps and hamstring muscle strength tests.
There were 168 subjects (80%) who returned for the 20-year follow-up, with a mean (±SD) age of 45 ± 9 years, mean body mass index of 27 ± 4, and median Tegner activity level of 4 (range, 0-9). The prevalence of radiographic TF and PF OA at the 20-year follow-up was 42% and 21%, respectively. Patients with ACL injuries and other combined injuries had significantly higher prevalence of radiographic TF OA compared with those who had isolated ACL injury (P < .0001). There was a 13% increase in radiographic TF OA (P = .001) and an 8% increase in PF OA (P = .015) from the 15- to the 20-year follow-up. A significant deterioration in knee symptoms and function was observed on the KOOS subscales (P ≤ .01), with the exception of quality of life (P = .14), as well as a decrease in quadriceps muscle strength and hamstring muscle strength (P < .0001).
The prevalence of radiographic TF and PF OA was 42% and 21%, respectively. A significantly higher prevalence of TF OA was found for subjects with combined injuries compared with those who had isolated ACL injury. The majority of the subjects were stable radiographically over the 5 years between follow-ups. A statistically significant deterioration in symptoms and function was noted, but the mean changes were of questionable clinical importance.
对于前交叉韧带重建（ACLR）术后超过15年的胫股（TF）和髌股（PF）骨关节炎（OA）进展以及膝关节功能变化，目前了解尚不充分。
研究ACLR术后15至20年时，孤立性损伤和合并性损伤患者膝关节OA的进展情况以及症状和功能的变化。
队列研究；证据等级，2级。
前瞻性随访210例接受ACLR的患者。在15年和20年随访时，获取X线片并按照凯尔格伦和劳伦斯（K-L）分级系统进行分类。采用膝关节损伤和骨关节炎转归评分（KOOS）以及等速股四头肌和腘绳肌力量测试对症状和功能进行评估。
168例患者（80%）返回接受20年随访，平均（±标准差）年龄为45±9岁，平均体重指数为27±4，Tegner活动水平中位数为4（范围0 - 9）。20年随访时，影像学检查显示TF OA和PF OA的患病率分别为42%和21%。与孤立性前交叉韧带损伤患者相比，合并前交叉韧带损伤和其他合并性损伤的患者影像学检查显示TF OA的患病率显著更高（P < .0001）。从15年随访到20年随访，影像学检查显示TF OA患病率增加了13%（P = .001），PF OA患病率增加了8%（P = .015）。在KOOS各分量表上观察到膝关节症状和功能显著恶化（P≤.01），生活质量分量表除外（P = .14），同时股四头肌力量和腘绳肌力量下降（P < .0001）。
影像学检查显示TF OA和PF OA的患病率分别为42%和21%。与孤立性前交叉韧带损伤患者相比，合并性损伤患者TF OA的患病率显著更高。在两次随访的5年期间，大多数患者影像学表现稳定。症状和功能在统计学上有显著恶化，但平均变化的临床意义存疑。
