前交叉韧带重建术后非常长期的骨关节炎发生率：22 年随访的 182 例病例。
Very long-term osteoarthritis rate after anterior cruciate ligament reconstruction: 182 cases with 22-year' follow-up.
机构信息
Département de chirurgie orthopédique et traumatologique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France.
Département de chirurgie orthopédique et traumatologique, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen, France; Unité Inserm U1075 Comète, PFRS-université de Caen, 2, rue des Rochambelles, 14032 Caen cedex 5, France.
出版信息
Orthop Traumatol Surg Res. 2020 May;106(3):459-463. doi: 10.1016/j.otsr.2019.09.034. Epub 2020 Feb 1.
BACKGROUND
Few data are available on the 20-year outcomes of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to assess the prevalence and risk factors of knee osteoarthritis at least 20 years after ACL reconstruction.
HYPOTHESIS
Factors associated with progression to knee osteoarthritis include meniscal lesions, level of physical activity, injury-to-surgery time, body mass index, residual laxity, tunnel position and cartilage injury.
MATERIAL AND METHODS
One hundred and eighty two patients were included in a multicentre retrospective study conducted in the setting of a SoFCOT symposium. Females contributed two-thirds of the study population. ACL reconstruction was performed arthroscopically in 82% of cases, and a bone-patellar tendon-bone transplant was used in 92.8% of cases. Mean age at surgery was 26±7years. Clinical outcomes were assessed based on the objective and subjective IKDC scores and on the KOOS. Radiographic evidence of osteoarthritis was classified according to the IKDC. Factors evaluated for their ability to predict progression to osteoarthritis included age, sex, body mass index, level of physical activity, injury-to-surgery time, meniscectomy, cartilage injury, tunnel position and residual laxity.
RESULTS
At last follow-up, the objective IKDC score was A (normal) for 48%, B for 35%, and C or D for 17% of the knees. The mean subjective IKDC score was 82.7±13.1. Moderate-to-severe osteoarthritis was present in 29% of cases. The following risk factors for osteoarthritis were identified: medial or lateral meniscectomy, residual laxity, age >30years at surgery, and engaging in a pivoting sport. Meniscectomy was a major contributor to the development of osteoarthritis (17% of knees without vs. 46% with meniscectomy). Finally, the ACL re-tear rate was 13%.
CONCLUSION
ACL reconstruction provides satisfactory knee stability. The risk of subsequent osteoarthritis depends chiefly on the status of the menisci. Residual laxity is also associated with the development of osteoarthritis.
LEVEL OF EVIDENCE
IV, retrospective cohort study.
背景
关于前交叉韧带（ACL）重建后 20 年的结果数据较少。本研究的目的是评估 ACL 重建至少 20 年后膝关节骨关节炎的患病率和危险因素。
假设
与进展为膝关节骨关节炎相关的因素包括半月板损伤、身体活动水平、损伤至手术时间、体重指数、残余松弛度、隧道位置和软骨损伤。
材料与方法
本研究为多中心回顾性研究，在 SoFCOT 研讨会背景下开展，共纳入 182 例患者。女性占研究人群的三分之二。82%的病例采用关节镜下 ACL 重建，92.8%的病例采用骨-髌腱-骨移植。手术时的平均年龄为 26±7 岁。临床结果根据客观和主观 IKDC 评分以及 KOOS 进行评估。根据 IKDC 对骨关节炎的放射学证据进行分类。评估了年龄、性别、体重指数、身体活动水平、损伤至手术时间、半月板切除术、软骨损伤、隧道位置和残余松弛度等因素对进展为骨关节炎的预测能力。
结果
末次随访时，48%的膝关节客观 IKDC 评分为 A（正常），35%为 B，17%为 C 或 D。平均主观 IKDC 评分为 82.7±13.1。29%的病例存在中重度骨关节炎。骨关节炎的危险因素包括内侧或外侧半月板切除术、残余松弛度、手术时年龄＞30 岁以及从事旋转运动。半月板切除术是导致骨关节炎发生的主要因素（无半月板切除术的膝关节为 17%，有半月板切除术的膝关节为 46%）。最后，ACL 再撕裂率为 13%。
结论
ACL 重建可提供满意的膝关节稳定性。继发骨关节炎的风险主要取决于半月板的状态。残余松弛度也与骨关节炎的发生有关。
证据等级
IV，回顾性队列研究。
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