Lyon-Ortho-Clinic, Clinique de La Sauvegarde, Ramsay Santé, 29 Avenue des Sources, 69009, Lyon, France.
Clinique du Sport- Centre de Consultations, 2, rue Negrevergne, 33700, Merignac, France.
Knee Surg Sports Traumatol Arthrosc. 2021 Sep;29(9):2987-3000. doi: 10.1007/s00167-020-06318-5. Epub 2020 Oct 27.
Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years.
The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables.
A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range -4 to 4) and differential laxity also decreased (median - 4, range - 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031).
In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands.
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多项研究报告了老年患者 ACLR 后的满意临床结果，但均未评估半月板和软骨损伤的影响。本研究旨在评估半月板和软骨损伤对 50 岁以上患者 ACLR 结果的影响。
作者前瞻性收集了 228 例接受初次 ACLR 的患者记录，包括人口统计学资料、受伤至手术的时间、受伤是否与工作有关以及运动水平（竞技、娱乐或非竞技）。在至少 6 个月的随访时，记录膝关节损伤和骨关节炎结果评分（KOOS）、国际膝关节文献委员会（IKDC）评分和 Tegner 活动水平，并使用仪器测角仪设备测量前胫骨平移（ATT）的侧间差异来评估差异松弛度。进行回归分析以确定结果与半月板和软骨损伤以及九个独立变量之间的关联。
228 例在 ACLR 时年龄为 54.8±4.3 岁的患者在 14.3±3.8 个月的随访时进行了评估。KOOS 亚组的症状评分为 85±13，疼痛评分为 91±10，日常活动评分为 75±18，运动评分为 76±18，生活质量评分为 88±12。IKDC 评分为 A 者 84 例（37%），B 者 96 例（42%），C 者 29 例（13%），D 者 8 例（4%）。Tegner 评分显示下降（中位数 0，范围-4 至 4），差异松弛度也下降（中位数-4，范围-23.5 至 6.0）。BMI 较高（p=0.038）、女性（p=0.007）和内侧半月板切除术（p=0.029）患者的 KOOS 症状恶化。BMI 较高（p≤0.001）、女性（p=0.002）和未经治疗（p=0.047）或缝合（p=0.041）的内侧半月板损伤患者的 KOOS 疼痛恶化。差异松弛度随随访时间增加（p=0.024）和外侧软骨损伤（p=0.031）而增加。
在 50 岁以上患者初次 ACLR 中，女性和内侧半月板损伤显著影响 KOOS 症状和疼痛，而外侧软骨损伤显著增加差异松弛度。与内侧半月板完整的膝关节相比，缝合或未治疗的内侧半月板损伤患者疼痛更严重，而内侧半月板切除的膝关节症状更严重。这些发现具有临床意义，因为它们可以帮助外科医生根据患者的功能需求进行患者选择和调整预期。
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