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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study
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Low Rates of Radiographic Knee Osteoarthritis 5 Years After ACL Reconstruction or Rehabilitation Alone: The Delaware-Oslo ACL Cohort Study

机译：ACL重建或单独康复后的射线照相膝关节骨关节炎的低率：Delaware-Oslo ACL队列研究

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Background: Patients and clinicians often struggle to choose the optimal management strategy for posttraumatic knee osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. An evaluation of radiographic outcomes after a decision-making and treatment algorithm applicable in clinical practice can help to inform future recommendations and treatment choices. Purpose: To describe and compare 5-year radiographic outcomes and knee pain in individuals who had gone through our decision-making and treatment algorithm and chosen (1) early (&6 months) ACL reconstruction (ACLR) with pre- and postoperative rehabilitation, (2) delayed (&6 months) ACLR with pre- and postoperative rehabilitation, or (3) progressive rehabilitation alone. Study Design: Cohort study; Level of evidence, 2. Methods: We included 276 patients with unilateral ACL injury from a prospective cohort study. Patients chose management using a shared decision-making process and treatment algorithm, and 5-year postoperative radiographs of the index and contralateral knees were assessed using the Kellgren and Lawrence (K&L) classification and minimum joint space width measurements. We defined radiographic tibiofemoral OA as K&L grade ≥2 and knee pain as a Knee injury and Osteoarthritis Outcome Score for Pain ≤72. To further explore early radiographic changes, we included alternative cutoffs for radiographic knee OA using K&L grade ≥2/osteophyte (definite osteophyte without joint space narrowing) and K&L grade ≥1. Results: At 5 years, 64% had undergone early ACLR; 11%, delayed ACLR; and 25%, progressive rehabilitation alone. Radiographic examination was attended by 187 patients (68%). Six percent of the cohort had radiographic tibiofemoral OA (K&L grade ≥2) in the index knee; 4%, in the contralateral knee. Using the alternative cutoffs at K&L grade ≥2/osteophyte and K&L grade ≥1, the corresponding numbers were 20% and 33% in the index knee and 18% and 29% in the contralateral knee. Six percent had a painful index knee. There were no statistically significant differences in any radiographic outcomes or knee pain among the 3 management groups. Conclusion: There were no statistically significant differences in any 5-year radiographic outcomes or knee pain among the 3 management groups. Very few of the patients who participated in our decision-making and treatment algorithm had knee OA or knee pain at 5 years.
机译：背景：患者和临床医生常常努力选择前十字韧带（ACL）损伤后的暴风膝关节骨关节炎（OA）的最佳管理策略。在适用于临床实践中的决策和治疗算法之后的放射线显影结果的评估可以有助于告知未来的建议和治疗选择。目的：通过预先和术后康复，（2）延迟（＆amp; 6个月）ACLR与术前和术后康复，或仅限于逐步康复。研究设计：队列研究;证据水平，2.方法：我们包括从预期队列研究中包含276名单侧ACL损伤的患者。患者使用共享决策过程和治疗算法选择管理，使用Kellgren和Lawrence（K＆amp; L）分类和最小关节空间宽度测量来评估指数和对侧膝关节和对侧膝关节的5年术后X线片。我们将射线照相胫骨胫酯型为K＆amp; L级≥2和膝关节疼痛作为膝关节损伤和骨关节炎的疼痛≤72。为了进一步探索早期射线照相变化，我们包括使用K＆amp的射线照相膝关节OA的替代截止值; L级≥2/骨赘（无关节空间变窄的明确骨折）和K＆amp; l级别≥1。结果：5年后，64％的早期ACLR; 11％，延迟ACLR;和25％，单独进行渐进式康复。 187例患者（68％）出席了射线照相检查。六个群组中的六个占型膝盖的射线照相胫骨胫骨膜OA（K＆amp; l级别≥2）; 4％，在对侧膝盖。使用K＆amp的替代截止值; L级≥2/骨赘和K＆amp; L级别≥1，相应的数量为20％，折射率膝关节为18％和29％。六个百分之六个痛苦的膝盖。在3个管理组中，任何放射线摄影结果或膝关节疼痛都没有统计学上显着差异。结论：3个管理团体中的任何5年的放射线摄影结果或膝关节疼痛都没有统计学上显着差异。参与我们决策和治疗算法的患者中很少有膝盖OA或膝关节疼痛。

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