La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
Institute of Anatomy, Paracelsus Medical University Salzburg and Nuremburg, Salzburg, Austria.
Br J Sports Med. 2019 Sep;53(18):1168-1173. doi: 10.1136/bjsports-2018-100167. Epub 2019 Feb 8.
To evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy.
121 adults (ages 18-35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR (n=58)) and as-treated groups (rehabilitation+early ACLR (n=59) vs rehabilitation +delayed ACLR (n=29) vs rehabilitation alone (n=29)).
Patellofemoral cartilage thickness decreased -58 µm (95% CI -104 to -11 µm) over 5 years post-ACL rupture, with the greatest loss observed in trochlea during the first 2 years. Participants randomised to rehabilitation+early ACLR had significantly greater loss of patellar cartilage thickness compared with participants randomised to rehabilitation+optional delayed ACLR over the first 2 years (-25 µm (-52, 1 µm) vs +14 µm (-6 to 34 µm), p=0.02) as well as over 5 years (-36 µm (-78 to 5 µm) vs +18 µm (-7, 42 µm), p=0.02). There were no statistically significant differences in patellofemoral cartilage thickness changes between as-treated groups.
Patellofemoral (particularly trochlear) cartilage thickness loss was observed in young adults following acute ACL rupture. Early ACLR was associated with greater patellofemoral (particularly patellar) cartilage thickness loss over 5 years compared with optional delayed ACLR, indicating that early surgical intervention may be associated with greater short-term structural patellofemoral cartilage deterioration compared with optional delayed surgery.
ISRCTN84752559; Post-results.
评估前交叉韧带（ACL）损伤后 5 年内髌股关节软骨厚度的变化，并确定治疗策略的影响。
121 名年龄在 18-35 岁的成年人（26%为女性）发生 ACL 损伤，并参与了 KANON 随机对照试验。其中，117 人在基线时（ACL 断裂后<4 周）和至少一次随访测量时（2 年和 5 年）有 MRI 检查。通过手动分割（对采集顺序进行盲法）分析髌股关节软骨厚度。比较按方案分组（康复+早期 ACLR（n=59）与康复+选择性延迟 ACLR（n=58））和按实际处理分组（康复+早期 ACLR（n=59）与康复+延迟 ACLR（n=29）与康复单独治疗（n=29））之间髌股关节软骨厚度的变化。
ACL 损伤后 5 年内髌股关节软骨厚度平均减少 58µm（95%CI -104 至-11µm），前 2 年在滑车中观察到最大损失。与随机分组至康复+选择性延迟 ACLR 的患者相比，随机分组至康复+早期 ACLR 的患者在前 2 年内髌股关节软骨厚度的损失明显更大（-25µm[-52，1µm]与+14µm[-6 至 34µm]，p=0.02），5 年内也更大（-36µm[-78 至 5µm]与+18µm[-7，42µm]，p=0.02）。实际处理组之间髌股关节软骨厚度变化无统计学差异。
在急性 ACL 损伤后，年轻成年人观察到髌股关节（特别是滑车）软骨厚度的丢失。与选择性延迟 ACLR 相比，早期 ACLR 与 5 年内髌股关节（特别是髌骨）软骨厚度的更大损失相关，表明与选择性延迟手术相比，早期手术干预可能与短期结构性髌股关节软骨恶化相关。
ISRCTN84752559；试验后结果。
