Kleinsmith Rebekah M, Doxey Stephen A, Huyke-Hernández Fernando A, Only Arthur J, Kweon Christopher Y, Cunningham Brian P
TRIA Orthopaedic Center, Bloomington, Minnesota, U.S.A.; Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, Saint Louis Park, Minnesota, U.S.A.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, U.S.A.
Arthroscopy. 2024 Sep 26. doi: 10.1016/j.arthro.2024.09.034.
To evaluate short-term patient-reported outcomes (PROs) in patients aged 40 years and older after primary anterior cruciate ligament reconstruction (ACLR) between patients who received allograft or autograft. Secondary aims included assessing the effect of preexisting osteoarthritis on short-term PROs.
A retrospective review of an ambulatory surgery center's electronic medical record was conducted for patients who underwent primary ACLR between 2009 and 2022. Patients aged younger than 40 years, those who underwent index revision procedures and/or concomitant ligament repair/reconstructions, and those with incomplete baseline or short-term (1- or 2-year) Knee Injury and Osteoarthritis Outcomes Score (KOOS) scores were excluded. Patients who received allograft or autograft were matched according to sex and body mass index in a 2:1 fashion. PROs used included KOOS and Single Assessment Numeric Evaluation (SANE) at baseline and short-term follow-up (minimum of 1 year). Minimum clinically important difference was calculated in a distribution-based fashion. Osteoarthritis severity was determined on the basis of Kellgren-Lawrence (KL) grading of perioperative knee radiographs. Preexisting osteoarthritis was defined as KL grade 1 or more.
A total of 331 patients were included after matching (215 allograft and 116 autograft patients). The average age was 47.7 ± 6.0 years (range 40-66 years). Age differed significantly between the 2 groups, with the allograft cohort having an average age of 48.6 ± 6.0 years and the autograft cohort having an average age of 46.1 ± 5.7 years (P < .001). Short-term change in KOOS and SANE scores did not differ by graft type (P = .154, P = .556, respectively). Sixty-seven percent of all patients met minimum clinically important difference for KOOS and 82% of patients with complete baseline and short-term SANE scores met minimum clinically important difference for SANE. There was a statistically significant difference in rupture rates between the allograft and autograft cohorts (n = 9 allograft vs n = 0 autograft; P = .030). There was no difference in reoperation rates between the autograft and allograft cohorts (P = .453). Perioperative KL grading did not affect outcomes for either graft type (allograft: P = .905 vs autograft: P = .522).
Middle-aged patients undergoing ACLR with allograft or autograft demonstrate similar short-term PROs. Preexisting osteoarthritis similarly did not significantly affect short-term outcomes. However, rerupture rates were significantly greater in the allograft cohort than the autograft cohort.
Level III, therapeutic, retrospective, case control study.
评估40岁及以上患者在接受同种异体移植物或自体移植物进行初次前交叉韧带重建（ACLR）后的短期患者报告结局（PROs）。次要目的包括评估术前骨关节炎对短期PROs的影响。
对一家门诊手术中心2009年至2022年间接受初次ACLR的患者的电子病历进行回顾性研究。排除年龄小于40岁的患者、接受初次翻修手术和/或同期韧带修复/重建的患者，以及基线或短期（1年或2年）膝关节损伤和骨关节炎结局评分（KOOS）不完整的患者。接受同种异体移植物或自体移植物的患者按性别和体重指数以2:1的方式进行匹配。使用的PROs包括基线和短期随访（至少1年）时的KOOS和单项评估数字评价（SANE）。以基于分布的方式计算最小临床重要差异。根据围手术期膝关节X线片的Kellgren-Lawrence（KL）分级确定骨关节炎严重程度。术前骨关节炎定义为KL分级为1级或更高。
匹配后共纳入331例患者（215例同种异体移植物患者和116例自体移植物患者）。平均年龄为47.7±6.0岁（范围40 - 66岁）。两组患者年龄差异显著，同种异体移植物队列的平均年龄为48.6±6.0岁，自体移植物队列的平均年龄为46.1±5.7岁（P <.001）。KOOS和SANE评分的短期变化在移植物类型之间无差异（分别为P =.154，P =.556）。所有患者中有67%达到KOOS的最小临床重要差异，82%基线和短期SANE评分完整的患者达到SANE的最小临床重要差异。同种异体移植物和自体移植物队列之间的破裂率存在统计学显著差异（同种异体移植物n = 9例 vs 自体移植物n = 0例；P =.030）。自体移植物和同种异体移植物队列之间的再次手术率无差异（P =.453）。围手术期KL分级对两种移植物类型结局均无影响（同种异体移植物：P =.905 vs 自体移植物：P =.522）。
接受同种异体移植物或自体移植物进行ACLR的中年患者表现出相似的短期PROs。术前骨关节炎同样未显著影响短期结局。然而，同种异体移植物队列的再次破裂率显著高于自体移植物队列。
III级，治疗性，回顾性，病例对照研究。
