前交叉韧带重建联合外侧关节外手术长期随访中中度至重度骨关节炎的低患病率：一项系统评价和荟萃分析

Low prevalence of moderate to severe osteoarthritis at long-term follow-up after combined anterior cruciate ligament reconstruction and lateral extra-articular procedures: A systematic review and meta-analysis.

作者信息

Free Matthew, Hewison Christopher, Onggo James, Degen Ryan, Getgood Alan

机构信息

Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada.

Department of Orthopaedic Surgery, Austin Hospital, Heidelberg, Victoria, Australia.

出版信息

Knee Surg Sports Traumatol Arthrosc. 2025 Sep 4. doi: 10.1002/ksa.70059.

DOI:10.1002/ksa.70059

PMID:40905276

Abstract

PURPOSE

To determine the long-term risk of osteoarthritis following combined anterior cruciate ligament reconstruction (ACLR) and lateral extra-articular procedures (LEAP).

METHODS

A comprehensive search of multiple databases (EMBASE, OVID Medline, PubMed, Cochrane, and Scopus) was independently conducted by two reviewers according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies reporting on the rates of osteoarthritis following primary, arthroscopic ACLR combined with LEAP and a minimum 5-year follow-up were eligible for inclusion. The primary outcome was the prevalence of moderate to severe radiographic arthritis defined as International Knee Documentation Committee (IKDC) grades C or D, Ahlback grades 1-5, or Kellgren-Lawrence grades 3 or 4. A comparative meta-analysis of ACLR with and without LEAP was also performed.

RESULTS

A total of eight studies were included, comprising 849 patients who underwent ACLR with LEAP, and 164 who underwent isolated ACLR. Cumulative meta-analysis showed a 4% prevalence of moderate to severe osteoarthritis across all studies after ACLR with LEAP. Subgroup analysis demonstrated a prevalence of 3% in the 5-to-10-year follow-up group and 6% in the 10+ year follow-up group. In the three comparative cohort studies, meta-analysis revealed no statistically significant difference in moderate to severe osteoarthritis rates between ACLR with LEAP and ACLR alone.

CONCLUSION

This study demonstrates that long-term prevalence of moderate to severe osteoarthritis following combined ACLR with LEAP is low, and that the addition of LEAP does not increase the incidence compared to ACLR alone. These findings support the use of LEAP in selected patients, without concern for increased long-term joint degeneration.

LEVEL OF EVIDENCE

Level III, meta-analysis and systematic review.

摘要

目的

确定前交叉韧带重建术（ACLR）联合外侧关节外手术（LEAP）后骨关节炎的长期风险。

方法

两名研究者根据PRISMA（系统评价和Meta分析的首选报告项目）指南，独立对多个数据库（EMBASE、OVID医学数据库、PubMed、Cochrane和Scopus）进行全面检索。纳入报告初次关节镜下ACLR联合LEAP术后骨关节炎发生率且随访至少5年的研究。主要结局是定义为国际膝关节文献委员会（IKDC）C级或D级、阿尔贝克分级1-5级或凯尔格伦-劳伦斯分级3级或4级的中重度影像学关节炎的患病率。还对ACLR联合LEAP与未联合LEAP进行了比较Meta分析。

结果

共纳入8项研究，包括849例行ACLR联合LEAP的患者和164例行单纯ACLR的患者。累积Meta分析显示，ACLR联合LEAP术后所有研究中中重度骨关节炎的患病率为4%。亚组分析显示，5至10年随访组的患病率为3%，10年以上随访组的患病率为6%。在三项比较队列研究中，Meta分析显示ACLR联合LEAP与单纯ACLR在中重度骨关节炎发生率上无统计学显著差异。