Wellsandt Elizabeth, Axe Michael J, Snyder-Mackler Lynn
Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware, USA.
Division of Physical Therapy Education, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Orthop J Sports Med. 2018 Nov 26;6(11):2325967118810775. doi: 10.1177/2325967118810775. eCollection 2018 Nov.
The risk for knee osteoarthritis (OA) is substantially increased after anterior cruciate ligament (ACL) injury. Tools are needed to identify characteristics of patients after ACL injury who are most at risk for posttraumatic OA.
To determine whether clinical measures of knee function after ACL injury are associated with the development of radiographic knee OA 5 years after injury.
Cohort study; Level of evidence, 2.
A total of 76 athletes (mean age, 28.7 ± 11.3 years; 35.5% female) with ACL injury were included. Clinical measures of knee function (quadriceps strength, single-legged hop tests, patient-reported outcomes) were assessed after initial impairment resolution (baseline), after 10 additional preoperative or nonoperative rehabilitation sessions (posttraining), and 6 months after ACL reconstruction or nonoperative rehabilitation. Posterior-anterior bent-knee radiographs were completed at 5 years and graded in the medial compartment by use of the Kellgren-Lawrence system. Logistic regression models were used at each of the 3 time points to determine the ability of clinical measures to predict knee OA at 5 years.
Of the 76 patients, 9 (11.8%) had knee OA at 5 years. After adjustment for ACL reconstruction compared with nonoperative management, ipsilateral second ACL injuries, and the presence of contralateral knee OA, clinical measures of knee function at posttraining (6-m timed hop, Knee Outcomes Survey-Activities of Daily Living Scale) explained the most variance in posttraumatic OA development at 5 years ( = .006; ▵ , 27.5%). The 6-m hop test was the only significant posttraining predictor of OA at 5 years ( = .023; patients without OA, 96.6% ± 5.4%; patients with OA, 84.9% ± 14.1%). Similar significant group differences in hop scores and subjective knee function were present at baseline. No significant group differences in clinical measures existed at 6 months after ACL reconstruction or nonoperative rehabilitation.
Poor performance in single-legged hop tests early after ACL injury but not after reconstruction or nonoperative rehabilitation is associated with the development of radiographic posttraumatic knee OA 5 years after injury. Clinical measures of knee function were most predictive of subsequent OA development following an extended period of rehabilitation early after ACL injury.
前交叉韧带（ACL）损伤后，膝关节骨关节炎（OA）的风险大幅增加。需要一些工具来识别ACL损伤后创伤后OA风险最高的患者特征。
确定ACL损伤后膝关节功能的临床测量指标是否与损伤后5年的膝关节放射学OA的发生相关。
队列研究；证据等级，2级。
共纳入76名ACL损伤的运动员（平均年龄28.7±11.3岁；35.5%为女性）。在初始损伤恢复后（基线）、额外进行10次术前或非手术康复训练后（训练后）以及ACL重建或非手术康复6个月后，评估膝关节功能的临床测量指标（股四头肌力量、单腿跳测试、患者报告的结果）。在5年时拍摄屈膝前后位X线片，并使用凯尔格伦-劳伦斯系统对内髁进行分级。在3个时间点的每一个时间点，使用逻辑回归模型来确定临床测量指标预测5年时膝关节OA的能力。
76例患者中，9例（11.8%）在5年时患有膝关节OA。在对ACL重建与非手术治疗、同侧第二次ACL损伤以及对侧膝关节OA的存在进行调整后，训练后（6米定时单腿跳、膝关节结果调查-日常生活活动量表）的膝关节功能临床测量指标解释了5年时创伤后OA发展的最大差异（P = 0.006；△R²，27.5%）。6米单腿跳测试是5年时OA的唯一显著训练后预测指标（P = 0.023；无OA的患者，96.6%±5.4%；有OA的患者，84.9%±14.1%）。在基线时，单腿跳得分和主观膝关节功能也存在类似的显著组间差异。ACL重建或非手术康复6个月后，临床测量指标无显著组间差异。
ACL损伤后早期但不是重建或非手术康复后单腿跳测试表现不佳与损伤后5年创伤后膝关节放射学OA的发生相关。ACL损伤后早期经过较长时间康复后，膝关节功能的临床测量指标对随后OA发展的预测性最强。
