[국내논문]전방 십자 인대 재건술 후 골관절염의 발생 빈도 및 위험 인자들에 대한 비교 - 자가 슬개건과 자가 슬괴건을 이용한 방법 - Comparison of the Incidence and Risk Factors for Developing Osteoarthritis after ACL Reconstruction - Patellar Versus a Hamstring Autograft -원문보기
목적: 자가 골-슬개건-골과 자가 슬괵건을 이용한 전방 십자 인대 재건술 후, 골관절염의 발생률과 위험인자를 비교하고자 하였다. 대상 및 방법: 8년 이상 추시가 가능하였던, 자가 슬개건 53예 및 자가 슬괵건 40예를 이용한 전방 십대 인대 재건술을 시행한 총 93예를 대상으로 하였다. Kellgren and Lawrence의 분류에 따라 방사선상의 골관절염의 변화를 관찰하였고, 슬관절의 임상적 기능 (Lysholm 슬관절 점수, Tegner 운동 지수), 신체검사상의 전방 이완 정도 (Lachman 검사, Pivot-Shift 검사) 및 $Telos^{(R)}$ 기구를 이용한 전방 이완 정도를 비교 평가하였다. 결과: 자가 골-슬개건-골을 이용한 대상 중 24예 (45.3%)에서, 자가 슬괵건을 이용한 대상 중 14예 (35.0%)에서 방사선 검사상 골관절염 변화가 확인되었다. 동반된 연골판 손상 (골-슬개건-골 군 p<0.001, 슬괵건군 p=0.091), 수상에서 재건술까지 12개월 이상 경과 (골-슬개건-골 군 p=0.037, 슬괵건 군 p=0.021), 재건술 당시 연령 25세 이상 (골-슬개건-골 군p=0.003, 슬괵건 군 p=0.048) 등이 골관절염의 유의한 위험 인자로 나타났다. 하지만, 골관절염의 발생과 임상적 결과, 방사선적 안정성과의 연관성은 없었다. 결론: 자가 골-슬개건-골 및 자가 슬괵건을 이용한 전방 십자 인대 재건술 후 평균 10년 추시상 두 군 모두에서 임상적으로 양호한 결과를 얻었으나, 상당한 비율에서 방사선적 골관절염 변화가 관찰되었다. 또한 동반된 연골판 손상, 수상 후 재건술까지의 지연된 시간, 25세 이상의 연령 등의 다양한 인자가 이에 관련됨을 알 수 있었다.
목적: 자가 골-슬개건-골과 자가 슬괵건을 이용한 전방 십자 인대 재건술 후, 골관절염의 발생률과 위험인자를 비교하고자 하였다. 대상 및 방법: 8년 이상 추시가 가능하였던, 자가 슬개건 53예 및 자가 슬괵건 40예를 이용한 전방 십대 인대 재건술을 시행한 총 93예를 대상으로 하였다. Kellgren and Lawrence의 분류에 따라 방사선상의 골관절염의 변화를 관찰하였고, 슬관절의 임상적 기능 (Lysholm 슬관절 점수, Tegner 운동 지수), 신체검사상의 전방 이완 정도 (Lachman 검사, Pivot-Shift 검사) 및 $Telos^{(R)}$ 기구를 이용한 전방 이완 정도를 비교 평가하였다. 결과: 자가 골-슬개건-골을 이용한 대상 중 24예 (45.3%)에서, 자가 슬괵건을 이용한 대상 중 14예 (35.0%)에서 방사선 검사상 골관절염 변화가 확인되었다. 동반된 연골판 손상 (골-슬개건-골 군 p<0.001, 슬괵건군 p=0.091), 수상에서 재건술까지 12개월 이상 경과 (골-슬개건-골 군 p=0.037, 슬괵건 군 p=0.021), 재건술 당시 연령 25세 이상 (골-슬개건-골 군p=0.003, 슬괵건 군 p=0.048) 등이 골관절염의 유의한 위험 인자로 나타났다. 하지만, 골관절염의 발생과 임상적 결과, 방사선적 안정성과의 연관성은 없었다. 결론: 자가 골-슬개건-골 및 자가 슬괵건을 이용한 전방 십자 인대 재건술 후 평균 10년 추시상 두 군 모두에서 임상적으로 양호한 결과를 얻었으나, 상당한 비율에서 방사선적 골관절염 변화가 관찰되었다. 또한 동반된 연골판 손상, 수상 후 재건술까지의 지연된 시간, 25세 이상의 연령 등의 다양한 인자가 이에 관련됨을 알 수 있었다.
Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 4...
Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 40 cases using hamstring tendon were followed up at least 8 years. Radiographic evaluation was done according to the Kellgren and Lawrence's classification. Clinical functional testing (Lysholm Knee Scores, the Tegner activity scores) and laxity testing (Lachman, pivot shift tests), and the instrumented laxity testing with $Telos^{(R)}$ were all examined in relation to the development of osteoarthritis. Results: Radiographic osteoarthritic changes were detected in 24 patients (45.3%) in BPTB group and 14 patients (35.0%) in HT group. Accompanying meniscal injury (BPTB p 12 months (BPTB p=0.037; HT p=0.021), and patient's age at reconstruction of > 25 years (BPTB p=0.003; HT p=0.048) were found to be significant independent predictors of osteoarthritis. However, no statistically significant correlations were found between the development of osteoarthritis and the clinical outcome or the radiographic stability in both groups. Conclusion: Although ACL reconstruction using BPTB or HT autograft had good clinical results at an average follow-up of 10 years, considerable incidence of radiographic osteoarthritic changes were noted. Various factors such as accompanying meniscal injury, protracted time from injury to reconstruction, more than 25 years old at the time of reconstruction were related to radiographic osteoarthritic changes.
Purpose: To compare the incidence and risk factors for osteoarthritis after anterior cruciate ligament (ACL) reconstruction between two groups using bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autograft. Materials and Methods: 53 cases of ACL reconstruction using patellar tendon and 40 cases using hamstring tendon were followed up at least 8 years. Radiographic evaluation was done according to the Kellgren and Lawrence's classification. Clinical functional testing (Lysholm Knee Scores, the Tegner activity scores) and laxity testing (Lachman, pivot shift tests), and the instrumented laxity testing with $Telos^{(R)}$ were all examined in relation to the development of osteoarthritis. Results: Radiographic osteoarthritic changes were detected in 24 patients (45.3%) in BPTB group and 14 patients (35.0%) in HT group. Accompanying meniscal injury (BPTB p 12 months (BPTB p=0.037; HT p=0.021), and patient's age at reconstruction of > 25 years (BPTB p=0.003; HT p=0.048) were found to be significant independent predictors of osteoarthritis. However, no statistically significant correlations were found between the development of osteoarthritis and the clinical outcome or the radiographic stability in both groups. Conclusion: Although ACL reconstruction using BPTB or HT autograft had good clinical results at an average follow-up of 10 years, considerable incidence of radiographic osteoarthritic changes were noted. Various factors such as accompanying meniscal injury, protracted time from injury to reconstruction, more than 25 years old at the time of reconstruction were related to radiographic osteoarthritic changes.
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제안 방법
The aim of this study was to evaluate the radiographic prevalence of OA and the clinical outcome in the long term after ACL reconstruction with using either a BPTB or HT autograft. The secondary aim was to evaluate the influence of various factors on the prevalence of OA.
The radiographic assessment of the patient groups involved 2 views, namely, the standing anteroposterior view, the lateral view with 20 to 30 degrees of flexion of the knee at the last follow-up. We could obtain the radiographic images at all included patients.
All the functional assessments were performed at a minimum 8-year-follow up. Assessment of knee stability was undertaken using the Lachman, anterior drawer and pivot shift tests. Instrumented laxity testing was determined using the Telos® (Telos stress device; Austin & Associate, Inc.
At the last follow up, the patients were asked to note any kneeling pain, paresthesia or numbness at the autograft harvest site, crepitus and anterior knee pain. Kneeling pain was reported if it was present after the patients kneeled on a carpeted floor.
It is likely that very large multi-institutional databases would provide additional significant information. Second limitation in the design of our study is that there were meniscal injuries in addition to the ACL tear. It is difficult to obtain patients with solitary ACL tears and who are without any other intra-articular lesions.
Instrumented laxity testing was determined using the Telos® (Telos stress device; Austin & Associate, Inc., Polston, US) (20 lbs) by measuring the side-to-side differences in anterior displacement at 20 degrees of knee flexion5).
In addition, we evaluated the relationships between the patient’s age at the time of reconstruction, the time from injury to reconstruction and any accompanying meniscal injury with the presence of osteoarthritis at the final follow-up.
데이터처리
Descriptive statistics (arithmetic means, SDs, and ranges) were calculated using standard formulas. The results such as range of motion, the Lysholm score age, time to surgery and the follow-up period were compared between the BPTB and HT autograft groups by use of independent t test. Pearson’s chi-square test, Fisher’s exact test and odds ratios were used for analyzing the ordered categorical variables such as the OA grade, the Tegner activity score, Lachman test.
이론/모형
Pearson’s chi-square test, Fisher’s exact test and odds ratios were used for analyzing the ordered categorical variables such as the OA grade, the Tegner activity score, Lachman test.
Inter-rater agreement for radiographic osteoarthritic changes was estimated using Cohen’s κstatistic.
성능/효과
At the last follow up, both groups were improved in terms of the Lysholm knee score, the Tegner activity score, the Lachman test, the pivot-shift test and the side-to-side difference of the anterior laxity on the Telos® stress radiography (p<0.001).
The frequency and causes of OA currently remain controversial. In this study, the average follow-up after ACL reconstruction with using a patellar or hamstring tendon autograft was 10 years, and degenerative osteoarthritis developed in 38 of 93 patients (40.8%), and especially in the medial compartment. Some authors have reported that OA developed significantly more often in the BPTB group than that in the HT group12,24,27).
6 years. In their study, of the 53 cases that underwent early ACL reconstruction within 12 weeks of injury, degenerative changes were detected in 27% at 7-year postoperatively, and of the cases that underwent construction at more than 12 weeks after injury, degenerative changes were detected in 54%. Thus, it was suggested that reconstruction during the early period helps prevent the development of degenerative osteoarthritis.
In conclusion, radiographic osteoarthritic changes were identified in 40.8% of patients, although there was an improvement in the clinical results at an average follow- up of 10 years after anterior cruciate ligament reconstruction with using a patellar or hamstring tendon autograft. The frequency of radiographic degenerative changes of the knee was high in patients with accompanying meniscal injury, for patients with a protracted time from injury to reconstruction and for patients who were more than 25 years old at the time of reconstruction.
후속연구
The combination of these factors may have played an important role in the development of radiographic OA changes, which further investigation will be needed.
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