Massachusetts General Brigham Sports Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
University of Kentucky, Lexington, Kentucky, USA.
Am J Sports Med. 2023 May;51(6):1491-1496. doi: 10.1177/03635465231162105. Epub 2023 Apr 4.
The incidence of subsequent posttraumatic osteoarthritis (OA) diagnosis after surgery and the associated risk factors have been well reported after single-ligament anterior cruciate ligament (ACL) reconstruction; however, to date, the incidence of posttraumatic OA for those who have experienced multiligament knee injury (MLKI) has been reported only in relatively small, single-center studies.
To compare the incidence of OA diagnoses between patients with ACL injury versus patients with MLKI and to identify risk factors for OA diagnosis after MLKI.
Cohort study; Level of evidence, 3.
This study used the PearlDiver Mariner database, which contains insurance claims information on >151 million orthopaedic patients. We identified 2 cohorts for this study by using Current Procedural Terminology codes. The cohorts included patients between the ages of 16 and 60 who underwent either isolated ACL reconstruction (n = 114,282) or MLKI reconstruction (n = 3325) between July 1, 2010, and August 30, 2016. MLKI reconstruction was operationally defined as ACL reconstruction plus concurrent surgical treatment of ≥1 additional ligaments. Demographic factors, concomitant meniscal and cartilage procedures, and subsequent reoperation to restore motion were recorded, as was the incidence of knee OA diagnosis within 5 years of the index surgical procedure. OA incidence and demographic and surgical factors were compared (1) between ACL and MLKI groups and (2) between patients with MLKI either with or without OA diagnosis.
A significantly greater proportion of patients with MLKI were diagnosed with knee OA within 5 years of surgery (MLKI = 299/3325 [9.0%] vs ACL = 6955/114,282 [6.1%]; < .0001) (odds ratio [OR], 1.52; 95% CI, 1.35-1.72; < .001). Factors associated with increased odds of OA diagnosis after MLKI included age ≥30 years (OR, 5.90), reoperation to restore motion (OR, 2.54), obesity (OR, 1.96), mood disorder diagnoses (OR, 1.85), partial meniscectomy (OR, 1.85), and tobacco use (OR, 1.72). Concomitant meniscal repair was protective against OA diagnosis (OR, 0.06).
OA incidence was greater after MLKI reconstruction than after isolated ACL reconstruction. Potentially modifiable risk factors for OA after MLKI were identified and include obesity, tobacco use, depression, and the need for motion-restoring surgery.
单前交叉韧带（ACL）重建术后继发创伤后骨关节炎（OA）的发生率及其相关危险因素已得到充分报道；然而，迄今为止，多韧带膝关节损伤（MLKI）患者发生创伤后 OA 的发生率仅在相对较小的单中心研究中报道过。
比较 ACL 损伤患者与 MLKI 患者 OA 诊断的发生率，并确定 MLKI 后 OA 诊断的危险因素。
队列研究；证据水平，3 级。
本研究使用了 PearlDiver Mariner 数据库，该数据库包含了超过 15100 万例骨科患者的保险索赔信息。我们使用现行手术操作分类法（Current Procedural Terminology codes）代码确定了本研究的两个队列。队列包括年龄在 16 至 60 岁之间的患者，他们在 2010 年 7 月 1 日至 2016 年 8 月 30 日期间分别接受了单纯 ACL 重建（n=114282）或 MLKI 重建（n=3325）。MLKI 重建的定义是 ACL 重建加同时行≥1 条其他韧带的手术治疗。记录了患者的人口统计学因素、伴发半月板和软骨手术以及随后恢复运动的再次手术情况，还记录了索引手术 5 年内膝关节 OA 的诊断发生率。比较了（1）ACL 组和 MLKI 组之间，（2）MLKI 患者中有无 OA 诊断之间的 OA 发生率和人口统计学及手术因素。
在手术 5 年内，MLKI 患者中膝关节 OA 的诊断比例明显更高（MLKI=299/3325[9.0%] vs ACL=6955/114282[6.1%]；<.0001）（比值比[OR]，1.52；95%置信区间[CI]，1.35-1.72；<.001）。MLKI 后 OA 诊断的相关因素包括年龄≥30 岁（OR，5.90）、恢复运动的再次手术（OR，2.54）、肥胖（OR，1.96）、心境障碍诊断（OR，1.85）、半月板部分切除术（OR，1.85）和吸烟（OR，1.72）。同时行半月板修复术可降低 OA 诊断的风险（OR，0.06）。
MLKI 重建后 OA 的发生率高于单纯 ACL 重建。确定了 MLKI 后 OA 的潜在可修正危险因素，包括肥胖、吸烟、抑郁和需要恢复运动的手术。
