前交叉韧带重建后加速重返运动和 1 年时早期膝关节骨关节炎特征：一项探索性研究。

Accelerated Return to Sport After Anterior Cruciate Ligament Reconstruction and Early Knee Osteoarthritis Features at 1 Year: An Exploratory Study.

机构信息

Institute of Anatomy, Paracelsus Medical University, Strubergasse 21, Salzburg 5020, Austria; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia.

La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Australia.

出版信息

PM R. 2018 Apr;10(4):349-356. doi: 10.1016/j.pmrj.2017.09.005. Epub 2017 Sep 14.

DOI:10.1016/j.pmrj.2017.09.005

PMID:28919498

Abstract

BACKGROUND

A timely return to competitive sport is a primary goal of anterior cruciate ligament reconstruction (ACLR). It is not known whether an accelerated return to sport increases the risk of early-onset knee osteoarthritis (KOA).

OBJECTIVE

To determine whether an accelerated return to sport post-ACLR (ie, <10 months) is associated with increased odds of early KOA features on magnetic resonance imaging (MRI) 1 year after surgery and to evaluate the relationship between an accelerated return to sport and early KOA features stratified by type of ACL injury (isolated or concurrent chondral/meniscal injury) and lower limb function (good or poor).

DESIGN

Cross-sectional study.

SETTING

Private radiology clinic and university laboratory.

PARTICIPANTS

A total of 111 participants (71 male; mean age 30 ± 8 years) 1-year post-ACLR.

METHODS

Participants completed a self-report questionnaire regarding postoperative return-to-sport data (specific sport, postoperative month first returned), and isotropic 3-T MRI scans were obtained.

OUTCOME MEASURES

Early KOA features (bone marrow, cartilage and meniscal lesions, and osteophytes) assessed with the MRI OA Knee Score. Logistic regression analyses evaluated the odds of early KOA features with an accelerated return to sport (<10 months post-ACLR versus ≥10 months or no return to sport) in the total cohort and stratified by type of ACL injury and lower limb function.

RESULTS

Forty-six (41%) participants returned to competitive sport <10 months post-ACLR. An early return to sport was associated with significantly increased odds of bone marrow lesions (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-6.0) but not cartilage (OR 1.2, 95% CI 0.5-2.6) or meniscal lesions (OR 0.8, 95% CI 0.4-1.8) or osteophytes (OR 0.6, 95% CI 0.3-1.4). In those with poor lower limb function, early return to sport exacerbated the odds of bone marrow lesions (OR 4.6, 95% CI 1.6-13.5), whereas stratified analyses for type of ACL injury did not reach statistical significance.

CONCLUSION

An accelerated return to sport, particularly in the presence of poor lower limb function, may be implicated in posttraumatic KOA development.

LEVEL OF EVIDENCE

IV.

摘要

背景

前交叉韧带重建（ACLR）的主要目标之一是及时恢复竞技运动。但是否加快重返运动（即<10 个月）会增加早期膝关节骨关节炎（KOA）的风险尚不清楚。

目的

确定 ACLR 后加速重返运动（即<10 个月）是否与术后 1 年 MRI 上早期 KOA 特征的增加有关，并评估加速重返运动与早期 KOA 特征之间的关系，这些特征根据 ACL 损伤类型（单独或并发软骨/半月板损伤）和下肢功能（好或差）进行分层。

设计

横断面研究。

设置

私人放射科诊所和大学实验室。

参与者

共 111 名参与者（71 名男性；平均年龄 30±8 岁）在 ACLR 后 1 年。

方法

参与者完成了一份关于术后重返运动数据（特定运动、术后第几个月首次返回）的自我报告问卷，并获得了各向同性 3-T MRI 扫描。

结果

111 名参与者中有 46 名（41%）在 ACLR 后<10 个月内重返竞技运动。加速重返运动（<10 个月 vs ≥10 个月或无重返运动）与骨髓病变的可能性显著增加有关（比值比[OR]2.7，95%置信区间[CI]1.3-6.0），但与软骨（OR 1.2，95%CI0.5-2.6）或半月板病变（OR 0.8，95%CI0.4-1.8）或骨赘（OR 0.6，95%CI0.3-1.4）无关。在下肢功能较差的患者中，早期重返运动加剧了骨髓病变的可能性（OR4.6，95%CI1.6-13.5），而 ACL 损伤类型的分层分析则没有达到统计学意义。