前交叉韧带重建后 10 年创伤后骨关节炎的临床 X 线发生率：来自 MOON 巢式队列的数据。
The Clinical Radiographic Incidence of Posttraumatic Osteoarthritis 10 Years After Anterior Cruciate Ligament Reconstruction: Data From the MOON Nested Cohort.
机构信息
Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
Am J Sports Med. 2021 Apr;49(5):1251-1261. doi: 10.1177/0363546521995182.
BACKGROUND
The incidence of posttraumatic osteoarthritis (PTOA) based on clinical radiographic grading criteria at 10 years after anterior cruciate ligament (ACL) reconstruction (ACLR) has not been well-defined in a prospective cohort of young athletic patients.
HYPOTHESIS
Among young athletic patients, there is a high incidence of clinical radiographic PTOA at 10 years after ACLR. Additionally, there is a significant difference in clinical radiographic osteoarthritis (OA) changes (joint space narrowing and osteophyte formation) between ACL-reconstructed and contralateral knees at 10 years.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
The first 146 patients in an ongoing nested cohort study of the Multicenter Orthopaedic Outcomes Network (MOON) prospective cohort presented for a minimum 10-year follow-up. Included patients had a sports-related ACL injury, were aged <33 years at the time of ACLR, had no history of ipsilateral or contralateral knee surgery, and did not undergo revision ACLR before follow-up. Bilateral knee metatarsophalangeal view radiographs were obtained and graded according to International Knee Documentation Committee (IKDC), Osteoarthritis Research Society International (OARSI), and modified Kellgren-Lawrence (KL) criteria by 2 blinded reviewers. The incidence and severity of ipsilateral and contralateral radiographic OA were determined among patients without a contralateral ACL injury before 10-year follow-up (N = 133).
RESULTS
Interrater reliability was substantial for the IKDC (Gwet Agreement Coefficient [AC] 1 = 0.71), moderate for the KL (0.48), and almost perfect for the OARSI (0.84) grading systems. Among patients with a contralateral radiographically normal knee, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The maximum side-to-side difference in the OARSI osteophyte grade in the medial or lateral compartment was 0 in 65% of patients, 1 in 20%, and ≥2 in 15%. The maximum side-to-side difference in the OARSI joint space narrowing grade was 0 in 77% of patients, 1 in 19%, and ≥2 in 4%.
CONCLUSION
In young active patients, the 10-year incidence of clinical radiographic PTOA after ACLR was 37% as defined by osteophytes and 23% as defined by joint space narrowing. The mean difference in the degree of osteophyte formation (≤1 grade in 85%) and joint space narrowing (≤1 grade in 96%) between the ACL-reconstructed and contralateral knees was small.
REGISTRATION
NCT02717559 (ClinicalTrials.gov identifier).
背景
在一项对年轻运动患者的前瞻性队列研究中，基于临床放射学分级标准，前交叉韧带（ACL）重建（ACLR）后 10 年的创伤后骨关节炎（PTOA）发生率尚不清楚。
假设
在年轻的运动患者中，ACL 重建后 10 年出现临床放射学 PTOA 的发生率较高。此外，在 ACLR 重建和对侧膝关节的 10 年随访中，在临床放射学骨关节炎（OA）变化（关节间隙狭窄和骨赘形成）方面存在显著差异。
研究设计
病例系列；证据水平，4 级。
方法
在多中心骨科结果网络（MOON）前瞻性队列的一项正在进行的嵌套队列研究中，前 146 名患者接受了至少 10 年的随访。纳入的患者有运动相关的 ACL 损伤，ACLR 时年龄<33 岁，同侧或对侧膝关节手术史，且在随访前未行 ACLR 翻修。对双侧膝关节跖趾关节视图进行 X 线摄影，并由 2 名盲法审阅者根据国际膝关节文献委员会（IKDC）、骨关节炎研究协会国际（OARSI）和改良 Kellgren-Lawrence（KL）标准进行分级。在没有对侧 ACL 损伤的情况下，确定了同侧和对侧放射学 OA 的发生率和严重程度（随访前 10 年 N=133）。
结果
IKDC（Gwet 一致性系数[AC]1=0.71）、KL（0.48）和 OARSI（0.84）分级系统的观察者间可靠性为中度至高度。在对侧膝关节 X 线正常的患者中，ACL 重建后 10 年临床放射学 PTOA 的发生率为 37%，定义为骨赘形成，23%定义为关节间隙狭窄。在外侧或内侧间室的 OARSI 骨赘分级中，最大的侧侧差异为 0 的患者占 65%，1 级的占 20%，≥2 级的占 15%。OARSI 关节间隙狭窄分级中最大的侧侧差异为 0 的患者占 77%，1 级的占 19%，≥2 级的占 4%。
结论
在年轻的活跃患者中，ACL 重建后 10 年的临床放射学 PTOA 发生率为 37%，定义为骨赘形成，23%定义为关节间隙狭窄。ACL 重建和对侧膝关节之间骨赘形成程度（85%≤1 级）和关节间隙狭窄（96%≤1 级）的平均差异较小。
登记
NCT02717559（ClinicalTrials.gov 标识符）。
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