Investigation performed at the Cleveland Clinic, Cleveland, Ohio, USA and Venderbilt Medical Center, Nashville, Tennessee.
Am J Sports Med. 2022 Mar;50(4):951-961. doi: 10.1177/03635465221074662.
Patients undergoing anterior cruciate ligament reconstruction (ACLR) are at an increased risk for posttraumatic osteoarthritis (PTOA). While we have previously shown that meniscal treatment with ACLR predicts more radiographic PTOA at 2 to 3 years postoperatively, there are a limited number of similar studies that have assessed cartilage directly with magnetic resonance imaging (MRI).
Meniscal repair or partial meniscectomy at the time of ACLR independently predicts more articular cartilage damage on 2- to 3-year postoperative MRI compared with a healthy meniscus or a stable untreated tear.
Cohort study; Level of evidence, 2.
A consecutive series of patients undergoing ACLR from 1 site within the prospective, nested Multicenter Orthopaedic Outcomes Network (MOON) cohort underwent bilateral knee MRI at 2 to 3 years postoperatively. Patients were aged <36 years without previous knee injuries, were injured while playing sports, and had no history of concomitant ligament surgery or contralateral knee surgery. MRI scans were graded by a board-certified musculoskeletal radiologist using the modified MRI Osteoarthritis Knee Score (MOAKS). A proportional odds logistic regression model was built to predict a MOAKS-based cartilage damage score (CDS) relative to the contralateral control knee for each compartment as well as for the whole knee, pooled by meniscal treatment, while controlling for sex, age, body mass index, baseline Marx activity score, and baseline operative cartilage grade. For analysis, meniscal injuries surgically treated with partial meniscectomy or meniscal repair were grouped together.
The cohort included 60 patients (32 female; median age, 18.7 years). Concomitant meniscal treatment at the time of index ACLR was performed in 17 medial menisci (13 meniscal repair and 4 partial meniscectomy) and 27 lateral menisci (3 meniscal repair and 24 partial meniscectomy). Articular cartilage damage was worse in the ipsilateral reconstructed knee ( < .001). A meniscal injury requiring surgical treatment with ACLR predicted a worse CDS for medial meniscal treatment (medial compartment CDS: = .005; whole joint CDS: < .001) and lateral meniscal treatment (lateral compartment CDS: = .038; whole joint CDS: = .863). Other predictors of a worse relative CDS included age for the medial compartment ( < .001), surgically observed articular cartilage damage for the patellofemoral compartment ( = .048), and body mass index ( = .007) and age ( = .020) for the whole joint.
A meniscal injury requiring surgical treatment with partial meniscectomy or meniscal repair at the time of ACLR predicted worse articular cartilage damage on MRI at 2 to 3 years after surgery. Further research is required to differentiate between the effects of partial meniscectomy and meniscal repair.
接受前交叉韧带重建 (ACLR) 的患者患创伤后骨关节炎 (PTOA) 的风险增加。虽然我们之前已经表明 ACLR 时半月板治疗预测术后 2 至 3 年更广泛的放射学 PTOA，但很少有类似的研究直接通过磁共振成像 (MRI) 评估软骨。
ACLR 时半月板修复或部分切除术独立预测与健康半月板或稳定未治疗撕裂相比，在术后 2 至 3 年的 MRI 上有更多的关节软骨损伤。
队列研究；证据水平，2 级。
来自一个部位的连续系列接受 ACLR 的患者前瞻性、嵌套多中心骨科结果网络 (MOON) 队列，在术后 2 至 3 年内进行双侧膝关节 MRI。患者年龄 <36 岁，无膝关节既往损伤，运动时受伤，无同时伴发韧带手术或对侧膝关节手术史。MRI 扫描由经过董事会认证的肌肉骨骼放射科医生使用改良 MRI 骨关节炎膝关节评分 (MOAKS) 进行分级。建立了比例优势逻辑回归模型，以预测相对于对侧对照膝关节的 MOAKS 基于软骨损伤评分 (CDS)，每个隔间以及整个膝盖，按半月板治疗情况进行分组，同时控制性别、年龄、体重指数、基线 Marx 活动评分和基线手术软骨分级。对于分析，接受部分半月板切除术或半月板修复的手术治疗的半月板损伤被归为一组。
该队列包括 60 名患者（32 名女性；中位年龄 18.7 岁）。在 ACLR 指数时同时进行的半月板治疗在 17 个内侧半月板（13 个半月板修复和 4 个部分半月板切除术）和 27 个外侧半月板（3 个半月板修复和 24 个部分半月板切除术）中进行。患侧重建膝关节的关节软骨损伤更严重（<.001）。需要手术治疗的半月板损伤预测内侧半月板治疗的 CDS 更差（内侧间室 CDS：<.001；全关节 CDS：<.001）和外侧半月板治疗（外侧间室 CDS：<.038；全关节 CDS：<.863）。更差的相对 CDS 的其他预测因素包括内侧间室的年龄（<.001）、髌股关节的手术观察到的关节软骨损伤（<.048）以及体重指数（<.007）和全关节的年龄（<.020）。
ACLR 时需要手术治疗的半月板损伤，包括部分半月板切除术或半月板修复，预测术后 2 至 3 年 MRI 上的关节软骨损伤更严重。需要进一步研究以区分部分半月板切除术和半月板修复的影响。
