解剖 ACL 重建可降低创伤后骨关节炎的风险：一项至少 10 年随访的系统评价。
Anatomic ACL reconstruction reduces risk of post-traumatic osteoarthritis: a systematic review with minimum 10-year follow-up.
机构信息
Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, 3200 S. Water St., Pittsburgh, PA, 15203, USA.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2020 Apr;28(4):1072-1084. doi: 10.1007/s00167-019-05665-2. Epub 2019 Aug 30.
PURPOSE
To systematically review the literature for radiographic prevalence of osteoarthritis (OA) at a minimum of 10 years following anterior cruciate ligament (ACL) reconstruction (ACLR) with anatomic vs. non-anatomic techniques. It was hypothesized that the incidence of OA at long-term follow-up would be lower following anatomic compared to non-anatomic ACLR.
METHODS
A systematic review was performed by searching PubMed, MEDLINE, EMBASE, and the Cochrane Library, for studies reporting OA prevalence by radiographic classification scales at a minimum of 10 years following ACLR with autograft. Studies were categorized as anatomic if they met or exceeded a score of 8 according the Anatomic ACL Reconstruction Scoring Checklist (AARSC), while those with a score less than 8 were categorized as non-anatomic/non-specified. Secondary outcomes included graft failure and measures of knee stability (KT-1000, Pivot Shift) and functional outcomes [Lysholm, Tegner, subjective and objective International Knee Documentation Committee (IKDC) scores]. OA prevalence on all radiographic scales was recorded and adapted to a normalized scale.
RESULTS
Twenty-six studies were included, of which 5 achieved a score of 8 on the AARSC. Using a normalized OA classification scale, 87 of 375 patients (23.2%) had diagnosed OA at a mean follow-up of 15.3 years after anatomic ACLR and 744 of 1696 patients (43.9%) had OA at mean follow-up of 15.9 years after non-anatomic/non-specified ACLR. The AARSC scores were 9.2 ± 1.3 for anatomic ACLR and 5.1 ± 1.1 for non-anatomic/non-specified ACLR. Secondary outcomes were relatively similar between techniques but inconsistently reported.
CONCLUSIONS
This study showed that anatomic ACLR, defined as an AARSC score ≥ 8, was associated with lower OA prevalence at long-term follow-up. Additional studies reporting long-term outcomes following anatomic ACLR are needed, as high-level studies of anatomic ACLR are lacking. The AARSC is a valuable resource in performing and evaluating anatomic ACLR. Anatomic ACLR, as defined by the AARSC, may reduce the long-term risk of post-traumatic OA following ACL injury to a greater extent than non-anatomic ACLR.
LEVEL OF EVIDENCE
IV.
目的
系统回顾文献，以评估在前交叉韧带（ACL）重建（ACLR）后至少 10 年，解剖学与非解剖学技术的放射学 OA 患病率。假设与非解剖 ACLR 相比，解剖 ACLR 在长期随访中 OA 的发生率会更低。
方法
通过检索 PubMed、MEDLINE、EMBASE 和 Cochrane 图书馆，对使用自体移植物进行 ACLR 后至少 10 年的放射学分类量表报告 OA 患病率的研究进行系统评价。如果研究符合或超过解剖 ACLR 评分检查表（AARSC）的 8 分，则将其归类为解剖学，而得分低于 8 分的则归类为非解剖学/非特定。次要结局包括移植物失败以及膝关节稳定性（KT-1000、Pivot Shift）和功能结局[Lysholm、Tegner、主观和客观国际膝关节文献委员会（IKDC）评分]的测量。记录所有放射学量表上的 OA 患病率，并将其转换为归一化量表。
结果
共纳入 26 项研究，其中 5 项研究在 AARSC 中达到 8 分。使用归一化 OA 分类量表，在解剖 ACLR 后平均 15.3 年的随访中，375 例患者中有 87 例（23.2%）诊断为 OA，而非解剖学/非特定 ACLR 后平均 15.9 年的随访中，1696 例患者中有 744 例（43.9%）患有 OA。解剖 ACLR 的 AARSC 评分为 9.2±1.3，而非解剖学/非特定 ACLR 的评分为 5.1±1.1。两种技术的次要结局相对相似，但报告不一致。
结论
本研究表明，解剖 ACLR（AARSC 评分≥8）与长期随访中较低的 OA 患病率相关。需要进一步报告解剖 ACLR 的长期结果，因为缺乏高水平的解剖 ACLR 研究。AARSC 是进行和评估解剖 ACLR 的有价值的资源。根据 AARSC 定义的解剖 ACLR 可能比非解剖 ACLR 更能降低 ACL 损伤后创伤后 OA 的长期风险。
证据水平
IV。
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