Investigation performed at Cleveland Clinic, Cleveland, Ohio, USA, and Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Am J Sports Med. 2018 Mar;46(4):876-882. doi: 10.1177/0363546517751139. Epub 2018 Feb 2.
Anterior cruciate ligament (ACL) reconstruction can effectively return athletes to the playing field, but they are still at risk of developing posttraumatic osteoarthritis (PTOA). No studies have used multivariable analysis to evaluate the predictors of radiographic PTOA in the lateral compartment of the knee at short-term follow-up after ACL reconstruction.
To determine the predictors of radiographic joint space narrowing in the lateral compartment 2 to 3 years after ACL reconstruction in a young, active cohort.
Cohort study; Level of evidence, 2.
A nested cohort of 358 patients from the Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort who were aged ≤33 years, were injured playing a sport, and had never undergone surgery on the contralateral knee were followed up 2 years after ACL reconstruction with questionnaires and with weightbearing knee radiographs using the metatarsophalangeal (MTP) joint technique. The joint space width in the lateral compartment was measured using a semiautomatic computerized method, and multivariable predictive modeling was used to evaluate the relationship between meniscus treatment, cartilage injury, graft type, and joint space while adjusting for age, sex, body mass index, and Marx activity score.
The mean lateral joint space width was 0.11 mm narrower on the ACL-reconstructed knee compared with the contralateral healthy knee (7.69 mm vs 7.80 mm, respectively; P < .01). Statistically significant predictors of a narrower joint space width on the ACL-reconstructed knee included lateral meniscectomy ( P < .001) and a Marx activity score less than 16 points ( P < .001).
This study identifies lateral meniscectomy and a lower baseline Marx activity score to be predictors of radiographic joint space narrowing in the lateral compartment 2 to 3 years after ACL reconstruction in young, active patients without a prior knee injury.
前交叉韧带（ACL）重建可以有效地使运动员重返赛场，但他们仍有发生创伤后骨关节炎（PTOA）的风险。目前尚无研究使用多变量分析来评估 ACL 重建后短期随访时膝关节外侧间室的放射影像学 PTOA 的预测因素。
确定 ACL 重建后 2 至 3 年内年轻活跃患者中膝关节外侧间室出现放射影像学关节间隙变窄的预测因素。
多中心骨科结局网络（MOON）前瞻性队列的嵌套队列研究；证据等级，2 级。
对 MOON 前瞻性队列中年龄≤33 岁、因运动受伤且对侧膝关节从未接受过手术的 358 例患者进行了一项巢式队列研究，在 ACL 重建后 2 年通过问卷调查和跖趾关节（MTP）技术的负重膝关节 X 线片进行随访。使用半自动计算机化方法测量外侧间室的关节间隙宽度，并进行多变量预测模型分析，以评估半月板处理、软骨损伤、移植物类型与关节间隙之间的关系，同时调整年龄、性别、体重指数和 Marx 活动评分。
与对侧健康膝关节相比，ACL 重建膝关节的外侧关节间隙宽度平均变窄 0.11mm（分别为 7.69mm 和 7.80mm；P <.01）。ACL 重建膝关节关节间隙变窄的统计学显著预测因素包括外侧半月板切除术（P <.001）和 Marx 活动评分低于 16 分（P <.001）。
本研究确定外侧半月板切除术和较低的基线 Marx 活动评分是 ACL 重建后 2 至 3 年内年轻活跃患者且无既往膝关节损伤的膝关节外侧间室放射影像学关节间隙变窄的预测因素。
