目的:确定和量化创伤性膝关节损伤后骨关节炎(OA)的潜在危险因素。
方法:系统评价和荟萃分析,使用随机效应模型在超过四项研究中评估了个体危险因素的OA几率。剩余的危险因素进行了半定量综合。修改后的等级(建议评估的等级,开发和评估)指导评估的预后因素方法。
方法:MEDLINE,EMBASE,中部,SPORTDiscus,CINAHL从成立到2009-2021年进行搜索。
UNASSIGNED:随机对照试验和队列研究评估创伤性膝关节损伤患者症状性或结构性OA的危险因素,平均损伤年龄≤30岁,至少2年随访。
结果:在66项纳入研究中,确定了81个独特的潜在风险因素。在64%和49%的研究中,由于减员或混淆而导致的偏倚风险较高。分别。结构性OA的十个危险因素进行了荟萃分析(性别,前交叉韧带(ACL)撕裂的康复治疗,ACL重建(ACLR),ACLR年龄,ACLR体重指数,ACLR移植源,ACLR移植物增强,ACLR+软骨损伤,ACLR+半月板部分切除术,ACLR+全内侧半月板切除术)。非常低的确定性证据表明,与ACLR+软骨损伤相关的结构性OA的几率增加(OR=2.31;95%CI1.35至3.94),ACLR+半月板部分切除术(OR=1.87;1.45至2.42)和ACLR+全内侧半月板切除术(OR=3.14;2.20至4.48)。半定量合成确定了中等确定性的证据,即十字韧带,侧副韧带,半月板,软骨,髌骨/胫股脱位,骨折和多结构损伤增加了有症状OA的几率.
结论:中度确定性证据表明,各种单结构和多结构膝关节损伤(ACL撕裂以外)增加了有症状的OA的几率。风险因素异质性,偏见的高风险,危险因素和OA定义的不一致使得确定预防创伤后膝关节OA的治疗目标具有挑战性。
OBJECTIVE: To identify and quantify potential risk factors for osteoarthritis (OA) following traumatic knee injury.
METHODS: Systematic review and meta-analyses that estimated the odds of OA for individual risk factors assessed in more than four studies using random-effects models. Remaining risk factors underwent semiquantitative synthesis. The modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach for prognostic factors guided the assessment.
METHODS: MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to 2009-2021.
UNASSIGNED: Randomised controlled trials and cohort studies assessing risk factors for symptomatic or structural OA in persons with a traumatic knee injury, mean injury age ≤30 years and minimum 2-year follow-up.
RESULTS: Across 66 included studies, 81 unique potential risk factors were identified. High risk of bias due to attrition or confounding was present in 64% and 49% of studies, respectively. Ten risk factors for structural OA underwent meta-analysis (sex, rehabilitation for anterior cruciate ligament (ACL) tear, ACL reconstruction (ACLR), ACLR age, ACLR body mass index, ACLR graft source, ACLR graft augmentation, ACLR+cartilage injury, ACLR+partial meniscectomy, ACLR+total medial meniscectomy). Very-low certainty evidence suggests increased odds of structural OA related to ACLR+cartilage injury (OR=2.31; 95% CI 1.35 to 3.94), ACLR+partial meniscectomy (OR=1.87; 1.45 to 2.42) and ACLR+total medial meniscectomy (OR=3.14; 2.20 to 4.48). Semiquantitative syntheses identified moderate-certainty evidence that cruciate ligament, collateral ligament, meniscal, chondral, patellar/tibiofemoral dislocation, fracture and multistructure injuries increase the odds of symptomatic OA.
CONCLUSIONS: Moderate-certainty evidence suggests that various single and multistructure knee injuries (beyond ACL tears) increase the odds of symptomatic OA. Risk factor heterogeneity, high risk of bias, and inconsistency in risk factors and OA definition make identifying treatment targets for preventing post-traumatic knee OA challenging.