Oak Sameer R, Cantrell William A, Altahawi Faysal, Li Xiaojuan, Winalski Carl S, Flanigan David C, Reinke Emily K, Huston Laura J, Jones Morgan H, Spindler Kurt P
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA.
Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Orthop J Sports Med. 2021 Jan 12;9(1):2325967120973050. doi: 10.1177/2325967120973050. eCollection 2021 Jan.
The prevalence of patellofemoral joint (PFJ) osteoarthritis ranges from 8% to 47% at 7 to 10 years after anterior cruciate ligament reconstruction (ACLR) using bone-patellar tendon-bone (BTB) autograft. In performing BTB ACLR, some hypothesize that either trauma caused by harvest of the BTB autograft or altered biomechanics contributes to PFJ posttraumatic osteoarthritis.
PURPOSE/HYPOTHESIS: To determine whether knees with ACLR using a BTB autograft show early signs of posttraumatic osteoarthritis as compared with the contralateral uninjured knee 2 years after ACLR. We hypothesized that a BTB autograft will not increase the prevalence of PFJ osteoarthritis.
Cohort study; Level of evidence, 3.
Bilateral knee 3-T magnetic resonance imaging (MRI) scans were collected in 57 patients (mean age, 20.3 years; 28 men) from a single site at a minimum of 2 years after ACLR. Structural MRI assessment of the knees was performed using the MRI Osteoarthritis Knee Score semiquantitative scoring system by a board-certified musculoskeletal radiologist. The presence of cartilage defects in the patellofemoral compartment was compared between the reconstructed and contralateral uninjured knees using logistic regression analyses.
There were no significant differences in the prevalence of cartilage defects (full thickness or any thickness) in the PFJ between the BTB ACLR knees and the contralateral control knees: 38.6% of BTB ACLR knees had PFJ cartilage defects versus 31.6% of contralateral control knees ( > .391). The 95% CI for the difference between these groups was -9.0% to 23.0%.
When comparing BTB ACLR knees with the uninjured contralateral knees in the study patients, we failed to observe statistically significant differences in the prevalence of PFJ cartilage lesions of full thickness or any thickness. These results should be used in shared decision-making with athletes when choosing the appropriate autograft during reconstruction. Our wide 95% CIs secondary to a smaller sample size demonstrate a need for larger studies in this area to more accurately describe the difference between the operative and contralateral knees.
使用骨-髌腱-骨（BTB）自体移植物进行前交叉韧带重建（ACLR）后7至10年，髌股关节（PFJ）骨关节炎的患病率在8%至47%之间。在进行BTB ACLR时，一些人推测，BTB自体移植物取材引起的创伤或生物力学改变是导致PFJ创伤后骨关节炎的原因。
目的/假设：确定与ACLR术后2年对侧未受伤膝关节相比，使用BTB自体移植物进行ACLR的膝关节是否显示创伤后骨关节炎的早期迹象。我们假设BTB自体移植物不会增加PFJ骨关节炎的患病率。
队列研究；证据等级，3级。
在一个研究点对57例患者（平均年龄20.3岁；28例男性）进行双侧膝关节3-T磁共振成像（MRI）扫描，扫描时间至少在ACLR术后2年。由一名获得委员会认证的肌肉骨骼放射科医生使用MRI膝关节骨关节炎评分半定量评分系统对膝关节进行结构MRI评估。使用逻辑回归分析比较重建膝关节和对侧未受伤膝关节髌股关节软骨缺损的情况。
BTB ACLR膝关节和对侧对照膝关节PFJ软骨缺损（全层或任何厚度）的患病率无显著差异：38.6%的BTB ACLR膝关节存在PFJ软骨缺损，而对侧对照膝关节为31.6%（P>.391）。两组之间差异的95%置信区间为-9.0%至23.0%。
在本研究患者中，将BTB ACLR膝关节与对侧未受伤膝关节进行比较时，我们未观察到全层或任何厚度的PFJ软骨损伤患病率存在统计学显著差异。这些结果应用于在重建过程中选择合适的自体移植物时与运动员共同决策。由于样本量较小，我们较宽的95%置信区间表明需要在该领域进行更大规模的研究，以更准确地描述手术膝关节和对侧膝关节之间的差异。
