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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Prognostic Factors for Patient-Reported Outcomes at 32 to 37 Years After Surgical or Nonsurgical Management of Anterior Cruciate Ligament Injury
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Prognostic Factors for Patient-Reported Outcomes at 32 to 37 Years After Surgical or Nonsurgical Management of Anterior Cruciate Ligament Injury

机译：患者报告的结果的预后因素在32〜37岁后的前手术或非前韧带损伤后的外科治疗

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Background: Knowledge to inform the identification of individuals with a poor long-term prognosis after anterior cruciate ligament (ACL) injury is limited. Identifying prognostic factors for long-term outcomes after ACL injury may inform targeted interventions to improve outcomes for those with a poor long-term prognosis. Purpose: To determine whether ACL treatment (early augmented or nonaugmented ACL repair plus rehabilitation, rehabilitation alone, or rehabilitation plus delayed ACL reconstruction [ACLR]) and 4-year measures (quadriceps and hamstrings strength, single-leg hop, knee laxity, flexion and extension deficit, self-reported knee function, activity level) are prognostic factors for patient-reported outcomes at 32 to 37 years after acute ACL injury. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 251 patients aged 15 to 40 years with acute ACL rupture between 1980 and 1985 were allocated to early ACL repair (augmented or nonaugmented) plus rehabilitation or to rehabilitation alone, based on birth year. One hundred ninety of 234 completed 32- to 37-year follow-up questionnaires (response rate, 81%); 18 people were excluded, resulting in 172 patients available for analysis (mean age, 59 ± 6 years; 28% female). Potential prognostic factors assessed 4 years after ACL injury were ACL treatment (early ACL repair, rehabilitation alone, or delayed ACLR), isokinetic quadriceps and hamstrings strength, single-leg hop performance, knee flexion and extension deficit, knee laxity, Tegner activity scale, and Lysholm score. Outcomes included Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the Anterior Cruciate Ligament Quality of Life (ACL-QOL) measure. Linear regression adjusted for age, sex, baseline meniscal injury, and contralateral ACL injury was used to assess potential prognostic factors for 32- to 37-year outcomes. Multiple imputation accounted for missing data. Results: A fair/poor Lysholm score (vs excellent/good) at 4 years was a prognostic factor for worse KOOS Pain (adjusted regression coefficient, ?12 [95% confidence interval (CI), ?19 to ?4]), KOOS Symptoms (?15 [95% CI, ?23 to ?7]), KOOS Sport and Recreation (?19 [95% CI, ?31 to ?8]), and ACL QOL (?9 [95% CI, ?18 to ?1]) scores. A 4-year single-leg hop limb symmetry index &90% was a prognostic factor for worse KOOS Pain (adjusted regression coefficient, ?9 [95% CI, ?17 to ?1]) and ACL QOL (?13 [95% CI, ?22 to ?3]) scores at long-term follow-up. A lower activity level, delayed ACLR, and increased knee laxity were prognostic factors in the crude analysis. Rehabilitation alone versus early repair, quadriceps and hamstring strength, and flexion and extension deficit were not related to 32- to 37-year outcomes. Conclusion: Reduced self-reported knee function and single-leg hop performance 4 years after ACL injury were prognostic factors for worse 32- to 37-year outcomes. Estimates exceeded clinically important thresholds, highlighting the importance of assessing these constructs when managing individuals with ACL injuries.
机译：背景：知识，以通知在前十字韧带（ACL）损伤后的长期预后识别个体的鉴定。在ACL损伤后确定长期结果的预后因素可能会通知有针对性的干预措施，以改善长期预后较差的人的结果。目的：确定ACL治疗是否（早期增强或非愈合或非愈合，单独的康复，或康复加上延迟ACL重建[ACLR]）和4年措施（Quadriceps和Hamstrings强度，单腿跳，膝盖松弛，屈曲和延伸赤字，自我报告的膝关节，活性水平是患者报告的结果的预后因素在急性ACL损伤后32至37岁。研究设计：队列研究;证据级别，2.方法：1980年至1985年间急性ACL破裂的共有251例患者急性ACL破裂分配给早期ACL修复（增强或非愈合）加上康复或仅基于诞生年份康复。百九十九人完成32至37年后续问卷（响应率，81％）; 18人被排除在外，导致172名可用于分析（平均年龄，59±6岁; 28％）。 ACL损伤4年评估的潜在预后因素是ACL治疗（仅早期ACL修复，单独康复，延迟ACLR），等渗Quadriceps和腿筋强度，单腿跳跃性能，膝关节屈曲和延伸赤字，膝盖松弛，TEGNERACTIVE规模，和Lysholm得分。结果包括膝关节损伤和骨关节炎结果评分（KOOS）分量和前十字架韧带质量（ACL-QOL）测量。用于年龄，性别，基线半月板损伤和对侧ACL损伤调整的线性回归用于评估32至37年的潜在预后因素。多重归咎于缺少数据。结果：4年的公平/较差的Lysholm评分（VS优秀/好的）是令人痛苦的预后因素（调整后的回归系数，？12 [95％置信区间（CI），？19至4]），KOOS症状（？15 [95％CI，23至7]），KOOS运动和娱乐（？19 [95％CI，α31至10]）和ACL QOL（？9 [95％CI，吗？18到？1]）分数。一个4年的单腿跳跃肢体对称指数＆amp; 90％是痛苦疼痛的预后因素（调整的回归系数，α9[95％ci，'17至1]）和ACL QOL（？13 [95％CI，Δ22至3]）在长期随访中得分。较低的活动水平，延迟ACLR和膝关节升高的增加是粗略分析中的预后因素。单独康复与早期修复，QuadRiceps和腿筋力量，屈曲和延伸赤字与32至37年的结果无关。结论：减少自我报告的膝关节函数和4年后的单腿跳跃性能，以至于预后因素为32至37年的结果。估计超过临床上重要的阈值，突出了在管理ACL伤害的个人时评估这些构建的重要性。

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