Department of Physiotherapy, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
Radiology, Universitatsklinikum Erlangen, Erlangen, Germany.
Br J Sports Med. 2023 Jan;57(2):91-98. doi: 10.1136/bjsports-2022-105473. Epub 2022 Nov 3.
Evaluate the natural course of anterior cruciate ligament (ACL) healing on MRI within 5 years of acute ACL rupture and compare 2-year and 5-year outcomes based on healing status and treatment group.
Secondary analysis of 120 Knee Anterior Cruciate Ligament Nonsurgical vs Surgical Treatment (KANON) trial participants randomised to rehabilitation and optional delayed ACL reconstruction (ACLR) or early ACLR and rehabilitation. ACL continuity on MRI (Anterior Cruciate Ligament OsteoArthritis Score 0-2) was considered evidence of ACL healing. Outcomes included Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS patient acceptable symptomatic state (PASS) and treatment failure criteria. Linear mixed models were used to estimate adjusted mean differences (95% CIs) in patient-reported sport and recreational function (KOOS-Sport/Rec) and quality of life (KOOS-QOL) at 2 and 5 years, between participants with MRI evidence of ACL healing and those who had (1) no evidence of ACL healing, (2) delayed ACLR or (3) early ACLR.
MRI evidence of ACL healing at 2-year follow-up was observed in 16 of 54 (30%, 95% CI 19 to 43%) participants randomised to optional delayed ACLR. Excluding participants who had delayed ACLR, 16 of 30 (53%, 36-70%) participants managed with rehabilitation-alone displayed MRI evidence of ACL healing. Two-year outcomes were better in the healed ACL group (n=16) compared with the non-healed (n=14) (mean difference (95% CI) KOOS-Sport/Rec: 25.1 (8.6-41.5); KOOS-QOL: 27.5 (13.2-41.8)), delayed ACLR (n=24) (KOOS-Sport/Rec: 24.9 (10.2-39.6); KOOS-QOL: 18.1 (5.4-30.8)) and early ACLR (n=62) (KOOS-Sport/Rec: 17.4 (4.1-30.7); KOOS-QOL: 11.4 (0.0-22.9)) groups. Five-year KOOS-QOL was better in the healed versus non-healed group (25.3 (9.4-41.2)). Of participants with MRI evidence of ACL healing, 63-94% met the PASS criteria for each KOOS subscale, compared with 29-61% in the non-healed or reconstructed groups.
MRI appearance of ACL healing after ACL rupture occurred in one in three adults randomised to initial rehabilitation and one in two who did not cross-over to delayed ACLR and was associated with favourable outcomes. The potential for spontaneous healing of the ACL to facilitate better clinical outcomes may be greater than previously considered.
ISRCTN84752559.
评估急性前交叉韧带（ACL）断裂后 5 年内 ACL 愈合的自然病程，并根据愈合情况和治疗组比较 2 年和 5 年的结果。
对 120 例膝关节前交叉韧带非手术与手术治疗（KANON）试验参与者的二次分析，这些参与者被随机分配到康复和可选的延迟 ACL 重建（ACLR）或早期 ACLR 和康复。MRI 上 ACL 的连续性（前交叉韧带骨关节炎评分 0-2）被认为是 ACL 愈合的证据。结果包括膝关节损伤和骨关节炎结果评分（KOOS）、KOOS 患者可接受的症状状态（PASS）和治疗失败标准。使用线性混合模型估计 2 年和 5 年时患者报告的运动和娱乐功能（KOOS-Sport/Rec）和生活质量（KOOS-QOL）的调整平均差异（95%CI），这些差异存在于 MRI 显示 ACL 愈合的参与者和以下参与者之间：（1）没有 ACL 愈合的证据，（2）延迟 ACLR，或（3）早期 ACLR。
在接受可选延迟 ACLR 治疗的 54 名参与者中，有 16 名（30%，95%CI 19-43%）在 2 年随访时 MRI 显示 ACL 愈合。排除接受延迟 ACLR 的参与者，单独接受康复治疗的 30 名参与者中有 16 名（53%，36-70%）显示 MRI 显示 ACL 愈合。与未愈合组（n=14）相比，愈合 ACL 组（n=16）的 2 年结果更好（平均差异（95%CI）KOOS-Sport/Rec：25.1（8.6-41.5）；KOOS-QOL：27.5（13.2-41.8））、延迟 ACLR 组（n=24）（KOOS-Sport/Rec：24.9（10.2-39.6）；KOOS-QOL：18.1（5.4-30.8））和早期 ACLR 组（n=62）（KOOS-Sport/Rec：17.4（4.1-30.7）；KOOS-QOL：11.4（0.0-22.9））。与未愈合组相比，愈合组的 5 年 KOOS-QOL 更好（25.3（9.4-41.2））。在 MRI 显示 ACL 愈合的参与者中，每个 KOOS 子量表的 PASS 标准的满足率为 63%-94%，而未愈合或重建组的满足率为 29%-61%。
ACL 断裂后 ACL 在最初接受康复治疗的成年人中三分之一出现 MRI 愈合迹象，而在未交叉到延迟 ACLR 的成年人中则有二分之一出现 MRI 愈合迹象，且与良好的结果相关。ACL 自发性愈合以促进更好的临床结果的可能性可能比以前认为的更大。
ISRCTN84752559。
