Cruz Christian A, Pruneski James A, McAllister Rebecca N, Riopelle David, Bottoni Craig R
Alexander T. Augusta Military Medical Center, Fort Belvoir, VA, USA.
Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Orthop J Sports Med. 2024 Dec 12;12(12):23259671241298753. doi: 10.1177/23259671241298753. eCollection 2024 Dec.
Posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament injury and reconstruction (ACLR) is a prevalent cause of long-term disability. Few studies have compared the effect of ACLR timing on the development of PTOA.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare the rate of PTOA at a long-term follow-up between patients who underwent early ACLR (<21 days after injury) versus delayed ACLR (>6 weeks after injury). The authors hypothesized that patients who underwent early ACLR would have lower rates of PTOA compared with the delayed ACLR cohort.
Cohort study; Level of evidence, 2.
The authors contacted patients from a previous prospective randomized controlled trial who were randomized to undergo either early (<21 days) or delayed (>6 weeks) ACLR with hamstring tendon autografts. Weightbearing radiographs were obtained at a minimum 15-year follow-up, and radiographic PTOA was evaluated using the Kellgren-Lawrence (K-L) classification system. The prevalence of pathologies was compared between the early and delayed groups using appropriate testing, and logistic regression was used to evaluate for associations with failure-a K-L grade of ≥2 or conversion to total knee arthroplasty (TKA).
At a mean follow-up of 15.6 years, radiographs were obtained for 58 (28 early, 30 delayed) of the original 69 (84.1%) patients. High rates of PTOA (K-L grade ≥2) were observed in the early (82.1%) and delayed (86.7%) cohorts ( = .634). Two (7.1%) patients in the early cohort converted to TKA compared with 4 (13.3%) patients in the delayed cohort ( = .44). Surgical timing did not affect arthritis severity (≥ .4), and no factors predicted developing radiographic PTOA in either cohort ( > .2). Increased time from injury decreased the odds of failure in the early ACLR cohort (odds ratio, 0.79; = .041).
In this study, >80% of patients who underwent ACLR with hamstring tendon autografts had radiographic evidence of PTOA at a mean 15.6-year follow-up, with no difference in the prevalence or severity of PTOA between the early and delayed groups. In addition, 11% of patients had converted to TKA by the time of the final follow-up, and the conversion rate did not differ according to the timing of ACLR.
前交叉韧带损伤与重建（ACLR）后的创伤后骨关节炎（PTOA）是导致长期残疾的常见原因。很少有研究比较ACLR时机对PTOA发生发展的影响。
目的/假设：本研究的目的是比较早期ACLR（受伤后<21天）与延迟ACLR（受伤后>6周）患者在长期随访时的PTOA发生率。作者假设，与延迟ACLR组相比，早期ACLR患者的PTOA发生率更低。
队列研究；证据等级，2级。
作者联系了之前一项前瞻性随机对照试验中的患者，这些患者被随机分配接受早期（<21天）或延迟（>6周）的自体腘绳肌腱ACLR。在至少15年的随访时获得负重X线片，并使用Kellgren-Lawrence（K-L）分类系统评估X线片上的PTOA。使用适当的检验比较早期和延迟组之间的病变患病率，并使用逻辑回归评估与失败（K-L分级≥2或转换为全膝关节置换术（TKA））的相关性。
在平均15.6年的随访时，对最初69例患者中的58例（28例早期，30例延迟）进行了X线片检查（84.1%）。早期组（82.1%）和延迟组（86.7%）均观察到较高的PTOA发生率（K-L分级≥2）（P = 0.634）。早期组有2例（7.1%）患者转换为TKA，而延迟组有4例（13.3%）患者转换为TKA（P = 0.44）。手术时机不影响关节炎严重程度（P≥0.4），且两组中均无因素可预测X线片上PTOA的发生（P>0.2）。受伤后时间延长降低了早期ACLR组失败的几率（优势比，0.79；P = 0.041）。
在本研究中，平均15.6年随访时，超过80%接受自体腘绳肌腱ACLR的患者有X线片证据显示存在PTOA，早期组和延迟组在PTOA的患病率或严重程度上无差异。此外，到最后随访时，11%的患者已转换为TKA，且转换率根据ACLR时机无差异。
