■报告的原发性前交叉韧带重建(ACLR)后创伤后膝关节骨关节炎(PTOA)的发生率差异很大。Further,在确定哪些患者在ACLR后存在PTOA风险以及是否存在可改变因素方面存在差距.
■目的:(1)确定原发性ACLR队列中PTOA的发生率;(2)确定原发性ACLR后与PTOA发展相关的患者和围手术期因素。
■队列研究;证据水平,3.
■来自KaiserPermanenteACLR注册的数据用于进行队列研究。确定了先前没有骨关节炎诊断的原发性ACLR患者(2009-2020)。使用具有多状态模型的Aalen-Johansen估计器计算PTOA的粗发生率。使用多状态Cox比例风险回归将患者和手术因素与原发性ACLR后PTOA发展的关联建模为事件发生时间。还进行了按年龄(<22岁和≥22岁)分层的模型,因为年龄的效应改变。
■研究样本包括41,976例原发性ACLR。PTOA的发生率为1.7%,5.1%,在2年、5年和10年的随访中占13.6%,分别。在总体队列和年龄分层组中一致确定的PTOA风险因素包括体重指数≥30与<30,同种异体或四头肌腱自体移植与绳肌腱自体移植。在考虑术后因素时,进一步确定ACLR后出现膝关节疼痛的患者。整个队列中PTOA的其他危险因素包括年龄≥22岁和<22岁,骨-髌腱-骨自体移植与绳肌腱自体移植,高血压,软骨损伤,半月板损伤,原发性ACLR合并半月板/软骨手术后翻修,多韧带损伤,受伤时的其他活动与运动相比,和胫骨隧道钻孔技术,而不是前内侧入口。
■ACLR后膝关节疼痛可能是PTOA的早期征兆。外科医生应考虑较高的体重指数和同种异体移植或股四头肌腱移植与PTOA发展的不利关系,因为这些都是风险较高的因素,无论患者在主要ACLR时的年龄如何。
UNASSIGNED: The reported incidence of posttraumatic knee osteoarthritis (PTOA) after primary anterior cruciate ligament reconstruction (ACLR) varies considerably. Further, there are gaps in identifying which patients are at risk for PTOA after ACLR and whether there are modifiable factors.
UNASSIGNED: To (1) determine the incidence of PTOA in a primary ACLR cohort and (2) identify patient and perioperative factors associated with the development of PTOA after primary ACLR.
UNASSIGNED: Cohort study; Level of evidence, 3.
UNASSIGNED: Data from the Kaiser Permanente ACLR Registry were used to conduct a cohort study. Patients who had undergone primary ACLR without a previous diagnosis of osteoarthritis were identified (2009-2020). The crude incidence of PTOA was calculated using the Aalen-Johansen estimator with a multistate model. The association of patient and operative factors with the development of PTOA after primary ACLR was modeled as a time to event using multistate Cox proportional hazards regression. Models stratified by age (<22 and ≥22 years) were also conducted because of the effect modification of age.
UNASSIGNED: The study sample included 41,976 cases of primary ACLR. The incidence of PTOA was 1.7%, 5.1%, and 13.6% at 2, 5, and 10 year follow-ups, respectively. Risk factors for PTOA that were consistently identified in the overall cohort and age-stratified groups included a body mass index ≥30 versus <30 and an allograft or quadriceps tendon autograft versus a hamstring tendon autograft. Patients presenting with knee pain after ACLR were further identified when considering postoperative factors. Other risk factors for PTOA in the overall cohort included age ≥22 versus <22 years, bone-patellar tendon-bone autograft versus hamstring tendon autograft, hypertension, cartilage injury, meniscal injury, revision after primary ACLR with concomitant meniscal/cartilage surgery, multiligament injury, other activity at the time of injury compared with sport, and tibial tunnel drilling technique rather than the anteromedial portal.
UNASSIGNED: Knee pain after ACLR may be an early sign of PTOA. Surgeons should consider the adverse associations of a higher body mass index and an allograft or quadriceps tendon autograft with the development of PTOA, as these were factors identified with a higher risk, regardless of a patient\'s age at the time of primary ACLR.