Medical Device Surveillance and Assessment, Kaiser Permanente, San Diego, California, USA.
Section of Rheumatology, Chobanian & Avedisian School of Medicine, Boston University, Boston, Massachusetts, USA.
Am J Sports Med. 2024 Aug;52(10):2482-2492. doi: 10.1177/03635465241261357. Epub 2024 Aug 3.
The reported incidence of posttraumatic knee osteoarthritis (PTOA) after primary anterior cruciate ligament reconstruction (ACLR) varies considerably. Further, there are gaps in identifying which patients are at risk for PTOA after ACLR and whether there are modifiable factors.
To (1) determine the incidence of PTOA in a primary ACLR cohort and (2) identify patient and perioperative factors associated with the development of PTOA after primary ACLR.
Cohort study; Level of evidence, 3.
Data from the Kaiser Permanente ACLR Registry were used to conduct a cohort study. Patients who had undergone primary ACLR without a previous diagnosis of osteoarthritis were identified (2009-2020). The crude incidence of PTOA was calculated using the Aalen-Johansen estimator with a multistate model. The association of patient and operative factors with the development of PTOA after primary ACLR was modeled as a time to event using multistate Cox proportional hazards regression. Models stratified by age (<22 and ≥22 years) were also conducted because of the effect modification of age.
The study sample included 41,976 cases of primary ACLR. The incidence of PTOA was 1.7%, 5.1%, and 13.6% at 2, 5, and 10 year follow-ups, respectively. Risk factors for PTOA that were consistently identified in the overall cohort and age-stratified groups included a body mass index ≥30 versus <30 and an allograft or quadriceps tendon autograft versus a hamstring tendon autograft. Patients presenting with knee pain after ACLR were further identified when considering postoperative factors. Other risk factors for PTOA in the overall cohort included age ≥22 versus <22 years, bone-patellar tendon-bone autograft versus hamstring tendon autograft, hypertension, cartilage injury, meniscal injury, revision after primary ACLR with concomitant meniscal/cartilage surgery, multiligament injury, other activity at the time of injury compared with sport, and tibial tunnel drilling technique rather than the anteromedial portal.
Knee pain after ACLR may be an early sign of PTOA. Surgeons should consider the adverse associations of a higher body mass index and an allograft or quadriceps tendon autograft with the development of PTOA, as these were factors identified with a higher risk, regardless of a patient's age at the time of primary ACLR.
初次前交叉韧带重建（ACLR）后创伤后膝关节骨关节炎（PTOA）的报告发病率差异很大。此外，在确定哪些患者在 ACLR 后有患 PTOA 的风险以及是否存在可改变的因素方面存在差距。
（1）确定原发性 ACLR 队列中 PTOA 的发病率，（2）确定与原发性 ACLR 后 PTOA 发展相关的患者和围手术期因素。
队列研究；证据水平，3 级。
使用 Kaiser Permanente ACLR 注册处的数据进行队列研究。确定了没有骨关节炎既往诊断的初次 ACLR 患者（2009-2020 年）。使用多状态模型的 Aalen-Johansen 估计器计算 PTOA 的粗发病率。使用多状态 Cox 比例风险回归模型将患者和手术因素与初次 ACLR 后 PTOA 的发展联系起来，作为时间事件建模。由于年龄的效应修饰，还进行了年龄<22 岁和≥22 岁的分层模型。
研究样本包括 41976 例初次 ACLR。PTOA 的发病率分别为 2 年、5 年和 10 年随访时的 1.7%、5.1%和 13.6%。在整个队列和年龄分层组中一致确定的 PTOA 危险因素包括体重指数≥30 与<30 和同种异体移植物或股四头肌肌腱移植物与腘绳肌腱移植物。在考虑术后因素时，进一步确定了 ACLR 后出现膝关节疼痛的患者。在整个队列中 PTOA 的其他危险因素包括年龄≥22 岁与<22 岁、骨-髌腱-骨移植物与腘绳肌腱移植物、高血压、软骨损伤、半月板损伤、初次 ACLR 后伴半月板/软骨手术的翻修、多韧带损伤、受伤时与运动相比的其他活动以及胫骨隧道钻技术而不是前内侧入路。
ACL 后膝关节疼痛可能是 PTOA 的早期迹象。外科医生应考虑较高的体重指数和同种异体移植物或股四头肌肌腱移植物与 PTOA 发展的不良关联，因为这些因素是在患者初次 ACLR 时具有较高风险的因素，无论其年龄大小。
