延迟前交叉韧带重建并仅采用运动疗法进行治疗可能会改变5年预后的预测因素：KANON试验的探索性分析。
Delaying ACL reconstruction and treating with exercise therapy alone may alter prognostic factors for 5-year outcome: an exploratory analysis of the KANON trial.
作者信息
Filbay Stephanie R, Roos Ewa M, Frobell Richard B, Roemer Frank, Ranstam Jonas, Lohmander L Stefan
机构信息
Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
出版信息
Br J Sports Med. 2017 Nov;51(22):1622-1629. doi: 10.1136/bjsports-2016-097124. Epub 2017 May 17.
AIM
Identify injury-related, patient-reported and treatment-related prognostic factors for 5-year outcomes in acutely ACL-ruptured individuals managed with early reconstruction plus exercise therapy, exercise therapy plus delayed reconstruction or exercise therapy alone.
METHODS
Exploratory analysis of the Knee Anterior Cruciate Ligament, Nonsurgical versus Surgical Treatment (KANON) trial (ISRCTN84752559). Relationships between prognostic factors (baseline cartilage, meniscus and osteochondral damage, baseline extension deficit, baseline patient-reported outcomes, number of rehabilitation visits, graft/contralateral ACL rupture, non-ACL surgery and ACL treatment strategy) and 5-year Knee Injury and Osteoarthritis Outcome Score (KOOS) pain, symptoms, sport/recreation and quality of life (QOL) scores were explored using multivariable linear regression. Estimates were adjusted for sex, age, body mass index, preinjury activity level, education and smoking.
RESULTS
For all participants (n=118), graft/contralateral ACL rupture, non-ACL surgery and worse baseline 36-item Short-Form Mental Component Scores were associated with worse outcomes. Treatment with exercise therapy alone was a prognostic factor for knee symptoms compared with early reconstruction plus exercise therapy (regression coefficient 10.1, 95% CI 2.3 to 17.9). Baseline meniscus lesion was associated with worse sport/recreation function (-14.4, 95% CI -27.6 to -1.3) and osteochondral lesions were associated with worse QOL (-12.3, 95% CI -24.3 to -0.4) following early reconstruction plus exercise therapy. In the same group, undergoing additional non-ACL surgery and worse baseline KOOS scores were prognostic for worse outcome on all KOOS subscales. Following delayed reconstruction, baseline meniscus damage was a prognostic factor for pain (14.3, 95% CI 0.7 to 27.9). Following exercise therapy alone, undergoing non-ACL surgery was prognostic for worse pain.
CONCLUSIONS
Treatment-dependent differences in prognostic factors for 5-year outcomes may support individualised treatment after acute ACL rupture in young active individuals.
TRIAL REGISTRATION NUMBER
Current Controlled Trials ISRCTN84752559.
目的
确定在接受早期重建加运动疗法、运动疗法加延迟重建或单纯运动疗法治疗的急性前交叉韧带（ACL）断裂患者中，与损伤相关、患者报告的和治疗相关的5年预后因素。
方法
对膝关节前交叉韧带非手术与手术治疗（KANON）试验（ISRCTN84752559）进行探索性分析。使用多变量线性回归探讨预后因素（基线软骨、半月板和骨软骨损伤、基线伸展缺陷、基线患者报告的结果、康复就诊次数、移植物/对侧ACL断裂、非ACL手术和ACL治疗策略）与5年膝关节损伤和骨关节炎结果评分（KOOS）疼痛、症状、运动/娱乐和生活质量（QOL）评分之间的关系。估计值根据性别、年龄、体重指数、伤前活动水平、教育程度和吸烟情况进行了调整。
结果
对于所有参与者（n = 118），移植物/对侧ACL断裂、非ACL手术以及较差的基线36项简短精神成分评分与较差的结果相关。与早期重建加运动疗法相比，单纯运动疗法治疗是膝关节症状的一个预后因素（回归系数10.1，95%CI 2.3至17.9）。在早期重建加运动疗法后基线半月板损伤与较差的运动/娱乐功能相关（-14.4，95%CI -27.6至-1.3），骨软骨损伤与较差的生活质量相关（-12.3，95%CI -24.3至-0.4）。在同一组中，接受额外的非ACL手术和较差的基线KOOS评分是所有KOOS子量表上较差结果的预后因素。在延迟重建后，基线半月板损伤是疼痛的一个预后因素（14.3，95%CI 0.7至27.9）。在单纯运动疗法后，接受非ACL手术是疼痛加重的预后因素。
结论
5年预后因素中与治疗相关的差异可能支持对年轻活跃个体急性ACL断裂后进行个体化治疗。
试验注册号
当前对照试验ISRCTN84752559。
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