前交叉韧带状态对全膝关节置换术后早期满意度和临床结果的影响

Ali Etemad-Rezaie, Tori A. Edmiston, S. Kearns, Philip H. Locker, D. Bohl, Andrew C Sexton, R. Frank, B. Levine
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引用次数: 1

摘要

背景:虽然全膝关节置换术(TKA)是一种治疗衰弱性关节炎的成功方法,但高达20%的患者可能对其结果不满意。不满意的一种假设是在TKA期间牺牲前交叉韧带(ACL)后,膝关节本身的运动学扭曲。本研究的目的是确定在骨性关节炎(OA)患者接受后路稳定(PS) TKA手术时ACL状态的影响。方法:对一名外科医生进行TKA的连续前瞻性患者进行前瞻性术中ACL状态评估,分为三组:1)完整,2)减弱或3)缺陷。每位患者的人口学、术前、术中和术后数据由两名独立的盲法观察者收集。结果包括患者满意度、膝关节疼痛评分(KSS)和功能评分(KSF)、Kellgren和Lawrence评分(K&L)、UCLA活动评分(UCLA)、短表12 (SF12)、EuroQol (EQ5D)和患者满意度。结果:116例患者中,33例(28.4%)患者为ACL缺陷膝,40例(34.5%)患者为ACL减弱,43例(37.1%)患者为ACL完整。前交叉韧带缺失的患者更有可能有更高的BMI (p= 0.007),并且是男性(p= 0.003)。前交叉韧带缺陷患者术前KSF明显降低,K&L评分明显升高(p=。009, p=1.26 × 10-7)。1年随访时,减毒组和缺陷组SF12PCS评分变化最大,分别增加9.9(±10.0)和10.8(±8.0),差异有统计学意义(p= 0.037)。术后总体KSS、KSF和基于ACL状态的满意度评分无显著差异(p=。574和p=。分别为529个)。结论:在一个相对较大的系列中,ACL缺陷患者更有可能具有较差的术前预后评分和相似或较好的术后预后评分。这表明那些ACL功能不全的患者可能会从TKA中获得更多的主观改善。ACL状态可以作为一个额外的手术标记,帮助骨科医生确定哪些患者将从TKA中获益最多。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Impact of Anterior Cruciate Ligament Status on Early Satisfaction and Clinical Outcomes Following Total Knee Arthroplasty
Background: While total knee arthroplasty (TKA) is a successful treatment for debilitating arthritis, up to 20% of patients may be dissatisfied with their outcome. One hypothesis for dissatisfaction is the distortion of native knee kinematics following sacrifice of the anterior cruciate ligament (ACL) during TKA. The purpose of this study was to determine the impact of ACL status at the time of surgery in patients undergoing Posterior Stabilized (PS) TKA for osteoarthritis (OA). Methods: A consecutive prospective series of patients undergoing TKA by a single surgeon underwent prospective intraoperative assessment of their ACL status divided into three different groups:1) intact, 2) attenuated, or 3) deficient. Demographic, preoperative, intraoperative, and postoperative data were collected for each patient by two blinded, independent observers. Outcomes included patient satisfaction and Knee Society Score for Pain (KSS) and Function (KSF), Kellgren and Lawrence (K&L), UCLA Activity Score (UCLA), Short Form-12 (SF12), EuroQol (EQ5D) and patient satisfaction. Results: Of 116 patients, 33 (28.4%) patients had an ACL deficient knee, 40 (34.5%) patients had an attenuated ACL, and 43 (37.1%) patients had an intact ACL. Those with absent ACL were significantly more likely to have a higher BMI (p=.007) and be male (p=.003). Patient with a deficient ACL had significantly lower preoperative KSF and higher K&L scores (p=.009, p=1.26 x 10-7). Attenuated and deficient groups had the greatest change in SF12PCS scores at their one-year follow-up with increases of 9.9 (±10.0) and 10.8 (±8.0), respectively (p=.037). No significant differences in overall postoperative KSS, KSF and satisfaction scores based on ACL status (p=.574 and p=.529, respectively) were found. Conclusion: In a relatively large series, patient with ACL deficiency were more likely to have worse pre-operative outcome scores and similar or better post-operative outcome scores. This suggests that those with ACL insufficiency may experience more subjective improvement from TKA. ACL status can be used as an additional surgical marker to help orthopaedic surgeons identify which patients would most benefit from TKA.
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