Identeg Fredrik, Senorski Eric Hamrin, Svantesson Eleonor, Samuelsson Kristian, Sernert Ninni, Kartus Jüri-Toomas, Sundemo David
Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
Orthop J Sports Med. 2020 Sep 29;8(9):2325967120951174. doi: 10.1177/2325967120951174. eCollection 2020 Sep.
Radiographic tibiofemoral (TF) osteoarthritis (OA) is common in patients after anterior cruciate ligament (ACL) reconstruction at long-term follow-up. The association between radiographic OA and patient-reported outcomes has not been thoroughly investigated.
To determine the association between radiographic TF OA and patient-reported outcome measure (PROM) scores at 16 years after ACL reconstruction.
Case-control study; Level of evidence, 3.
This study was based on 2 randomized controlled studies comprising 193 patients who underwent unilateral ACL reconstruction. A long-term follow-up was carried out at 16.4 ± 1.7 years after surgery and included a radiographic examination of the knee and recording of PROM scores. Correlation analyses were performed between radiographic OA (Kellgren-Lawrence [K-L], Ahlbäck, and cumulative Fairbank grades) and the PROMs of the International Knee Documentation Committee (IKDC) subjective knee form, Lysholm score, and Tegner activity scale. A linear univariable regression model was used to assess how the IKDC score differed with each grade of radiographic OA.
Of 193 patients at baseline, 147 attended the long-term follow-up. At long-term follow-up, 44.2% of the patients had a K-L grade of ≥2 in the injured leg, compared with 6.8% in the uninjured leg. The mean IKDC score at follow-up was 71.2 ± 19.9. Higher grades of radiographic OA were significantly correlated with lower IKDC and Lysholm scores ( = -0.36 to -0.22). Patients with a K-L grade of 3 to 4 had significantly lower IKDC scores compared with patients without radiographic OA (K-L grade 0-1). Adjusted beta values were -15.7 (95% CI, -27.5 to -4.0; = .0093; = 0.09) for K-L grade 3 and -25.2 (95% CI, -41.7 to -8.6; = .0033; = 0.09) for K-L grade 4.
There was a poor but significant correlation between radiographic TF OA and more knee-related limitations, as measured by the IKDC form and the Lysholm score. Patients with high grades of radiographic TF OA (K-L grade 3-4) had a statistically significant decrease in IKDC scores compared with patients without radiographic TF OA at 16 years after ACL reconstruction. No associations were found between radiographic TF OA and the Tegner activity level.
在长期随访中，影像学检查显示的胫股关节（TF）骨关节炎（OA）在接受前交叉韧带（ACL）重建手术的患者中很常见。影像学OA与患者报告的结局之间的关联尚未得到充分研究。
确定ACL重建术后16年时影像学TF OA与患者报告结局测量（PROM）评分之间的关联。
病例对照研究；证据等级为3级。
本研究基于2项随机对照研究，共纳入193例行单侧ACL重建手术的患者。术后16.4±1.7年进行长期随访，包括膝关节的影像学检查及PROM评分记录。对影像学OA（Kellgren-Lawrence [K-L]、Ahlbäck和累积Fairbank分级）与国际膝关节文献委员会（IKDC）主观膝关节量表、Lysholm评分及Tegner活动量表的PROM进行相关性分析。采用线性单变量回归模型评估IKDC评分在不同影像学OA分级中的差异。
193例患者中，147例接受了长期随访。在长期随访时，患侧膝关节K-L分级≥2级的患者占44.2%，而健侧为6.8%。随访时IKDC评分的平均值为71.2±19.9。影像学OA分级越高，与IKDC和Lysholm评分越低显著相关（相关系数为-0.36至-0.22）。与无影像学OA（K-L分级0-1级）的患者相比，K-L分级为3至4级的患者IKDC评分显著更低。K-L分级为3级时，调整后的β值为-15.7（95%CI，-27.5至-4.0；P = 0.0093；R² = 0.09）；K-L分级为4级时，调整后的β值为-25.2（95%CI，-41.7至-8.6；P = 0.0033；R² = 0.09）。
通过IKDC量表和Lysholm评分测量发现，影像学TF OA与更多膝关节相关功能受限之间存在较弱但显著的相关性。在ACL重建术后16年时，与无影像学TF OA的患者相比，影像学TF OA分级高（K-L分级3-4级）的患者IKDC评分在统计学上显著降低。未发现影像学TF OA与Tegner活动水平之间存在关联。
