Nolan Patrick, O'Sullivan Michael, Gorman Áine, Eustace Stephen, Mohammad Ausaf, Sheehan Eoin
Department of Orthopaedics, Midlands Regional Hospital Tullamore, Tullamore, IRL.
Department of Rheumatology, Midlands Regional Hospital Tullamore, Tullamore, IRL.
Cureus. 2021 Feb 5;13(2):e13160. doi: 10.7759/cureus.13160.
Introduction Patients with inflammatory arthropathies present a significant challenge to the arthroplasty surgeon when they present with symptomatic degenerative changes of their knee joint. Debate is ongoing regarding the selection of implants for this cohort of patients. There is conflicting evidence for the use of posterior-stabilising (PS) over cruciate-retaining (CR) designs in this cohort. Biologics are licensed for use in moderate-to-severe disease that has not responded to conventional treatment. To our knowledge, there are no studies that have assessed the integrity of the posterior cruciate ligament (PCL) on magnetic resonance imaging (MRI) in these patients with more advanced disease prescribed biologic agents. Aim The aim of this study is to assess the integrity of the PCL on MRI in patients with inflammatory arthritis who are prescribed biologic agents. Methods A case-control study was performed, with cases identified through chart review to confirm prescription of biologic agents for inflammatory arthropathies, who also had contemporaneous MRI knee scans performed. Knee MRIs for age- and sex-matched controls with osteoarthritis (OA) and meniscal pathology were identified from the National Joint Registry and the Hospital In-Patient Enquiry (HIPE), respectively. The MRIs were reviewed by two musculoskeletal radiologists who were blinded to the clinical details. They were asked to assess the MRIs to determine PCL integrity, synovial Inflammation, and any associated pathology. Results No difference was noted in the rate of synovitis, PCL attenuation, or PCL tears between the OA and inflammatory arthropathy groups (p > 0.05). Conclusions The results of this study show no difference in the integrity and continuity of the PCL in those patients for age- and sex-matched controls on MRI. This finding lends support to the use of CR total knee arthroplasty in patients with inflammatory arthropathy on biologic agents.
引言 当炎性关节病患者出现膝关节有症状的退行性改变时，给关节置换外科医生带来了重大挑战。关于该类患者植入物的选择，目前仍存在争议。对于在这一患者群体中使用后稳定型（PS）而非保留交叉韧带型（CR）设计，存在相互矛盾的证据。生物制剂被批准用于对传统治疗无反应的中重度疾病。据我们所知，尚无研究评估在这些使用生物制剂的病情更严重的患者中，磁共振成像（MRI）上后交叉韧带（PCL）的完整性。
目的 本研究的目的是评估使用生物制剂的炎性关节炎患者MRI上PCL的完整性。
方法 进行了一项病例对照研究，通过病历审查确定病例，以确认炎性关节病生物制剂的处方情况，这些患者同时也进行了膝关节MRI扫描。分别从国家关节注册中心和医院住院患者查询系统（HIPE）中确定年龄和性别匹配的骨关节炎（OA）和半月板病变对照的膝关节MRI。由两名对临床细节不知情的肌肉骨骼放射科医生对MRI进行审查。要求他们评估MRI以确定PCL完整性、滑膜炎和任何相关病变。
结果 OA组和炎性关节病组之间在滑膜炎发生率、PCL衰减或PCL撕裂方面未发现差异（p>0.05）。
结论 本研究结果表明，在MRI上年龄和性别匹配的对照组中，这些患者PCL的完整性和连续性没有差异。这一发现支持在使用生物制剂的炎性关节病患者中使用CR全膝关节置换术。
