Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Orthopedic Surgery, Yale University, New Haven, Connecticut, USA.
Am J Sports Med. 2021 Feb;49(2):442-449. doi: 10.1177/0363546520980431. Epub 2021 Jan 4.
The association between activity level after anterior cruciate ligament (ACL) reconstruction (ACLR) and development of posttraumatic osteoarthritis (PTOA) remains unclear. This study investigated the relationship of patient-reported outcomes and progressive cartilage degenerative changes at 3 years after ACLR.
Higher activity levels, as measured by Marx scores, are significantly correlated with early cartilage degeneration after ACLR.
Cohort study; Level of evidence, 2.
A total of 35 patients (16 women; mean age, 31.0 ± 7.6 years) with isolated ACLR and without pre-existing arthritis were prospectively enrolled. Patients reported Marx activity scores and Knee injury and Osteoarthritis Outcome Score (KOOS) scores and underwent Tρ magnetic resonance imaging (MRI) preoperatively, 6 months, 1 year, 2 years, and 3 years after ACLR with soft tissue graft (22 autograft). The change in cartilage relaxation times between preoperative and 3-year imaging was used to identify cartilage degeneration, defined as an increase in Tρ values by 14.3%. Correlation between Marx activity levels, KOOS scores, and Tρ degeneration was performed with the Spearman rank test. The Fisher exact test was used to test for association between Marx activity score cutoffs and degeneration. The Student test was used to compare Whole-Organ Magnetic Resonance Imaging Score (WORMS) and Tρ relaxation times. Significance was defined as < .05.
Sixteen patients (45.7%) showed evidence of cartilage degeneration at 3 years, most frequently in the medial compartment (n = 12; 34%). Higher Marx activity scores at 3 years correlated with cartilage degeneration in the medial femur (rho = 0.34; = .045), and medial tibia (rho = 0.43; = .01). A Marx score of 11 or greater at 3 years was significantly associated with medial compartment degeneration ( = .03), with a positive predictive value of 52.6%. No Marx score cutoff at years 1 or 2 predicted future cartilage degeneration. The KOOS Quality of Life score was inversely correlated with cartilage degeneration (rho = 0.38; = .02). WORMS did not correlate with degeneration of the medial compartment.
Increased activity at 3 years after ACLR was significantly associated with increased risk of medial compartment PTOA. While further research is needed to fully define these relationships, patients may be counseled that return to Marx activity levels of greater than 11 may be associated with a higher risk of medial compartment cartilage degeneration.
前交叉韧带（ACL）重建（ACLR）后活动水平与创伤后骨关节炎（PTOA）的发展之间的关系仍不清楚。本研究调查了 ACLR 后 3 年患者报告的结果与进行性软骨退行性变化之间的关系。
Marx 评分测量的较高活动水平与 ACLR 后早期软骨退化显著相关。
队列研究；证据水平，2。
共纳入 35 例（16 名女性；平均年龄 31.0±7.6 岁）孤立性 ACLR 且无先前关节炎的患者。患者报告 Marx 活动评分和膝关节损伤和骨关节炎结果评分（KOOS），并在 ACLR 前、6 个月、1 年、2 年和 3 年进行 Tρ磁共振成像（MRI），使用软组织移植物（22 个自体移植物）。使用术前和 3 年影像学之间软骨弛豫时间的变化来识别软骨退变，定义为 Tρ 值增加 14.3%。使用 Spearman 秩检验对 Marx 活动水平、KOOS 评分和 Tρ 退变之间进行相关性分析。使用 Fisher 确切检验检验 Marx 活动评分截点与退变的关联。使用 Student t 检验比较全器官磁共振成像评分（WORMS）和 Tρ 弛豫时间。定义显著性为 <.05。
16 例患者（45.7%）在 3 年内出现软骨退变证据，最常见于内侧（n=12；34%）。3 年时较高的 Marx 活动评分与内侧股骨（rho=0.34； =.045）和内侧胫骨（rho=0.43； =.01）的软骨退变相关。3 年时的 Marx 评分≥11 与内侧间室退变显著相关（ =.03），阳性预测值为 52.6%。1 年或 2 年时的任何 Marx 评分截点均不能预测未来的软骨退变。KOOS 生活质量评分与软骨退变呈负相关（rho=0.38； =.02）。WORMS 与内侧间室退变无相关性。
ACL 重建后 3 年活动水平增加与内侧间室 PTOA 风险增加显著相关。虽然需要进一步研究来充分定义这些关系，但可以告知患者，返回大于 11 的 Marx 活动水平可能与内侧间室软骨退变的风险增加相关。
