前交叉韧带损伤后手术与非手术治疗患者髌股关节骨关节炎的比较：系统评价与Meta分析
简介
本研究为系统评价与荟萃分析，旨在比较前交叉韧带（ACL）损伤后接受重建手术（ACL-R）与非手术治疗的髌股关节骨关节炎（PFOA）发生率。纳入6项研究，荟萃分析显示：ACL-R组发生PFOA的风险显著高于非手术组（OR=2.21；95%CI: 1.13-4.35；p=0.02）。其中，采用骨-髌腱-骨（BPTB）自体移植物的患者PFOA发生率显著高于腘绳肌腱…
英文摘要
PURPOSE: We hypothesized that patients undergoing anterior cruciate ligament reconstruction (ACL-R) are more likely to develop patellofemoral osteoarthritis (PFOA) than those with an ACL injury managed non-surgically. STUDY DESIGN: Systematic review and Meta-analysis. METHODS: A systematic literature review and meta-analysis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Studies reporting PFOA assessment by radiographic or magnetic resonance imaging after ACL-R compared to non-surgical treatment of ACL injury were included. Studies involving individuals with concurrent other ligamentous or chondral injuries treated surgically were excluded to minimize bias. RESULTS: A total of six studies were included in the systematic review. The meta-analysis demonstrated that patients undergoing ACL-R had a significantly higher likelihood of developing PFOA compared to those who received non-surgical treatment after ACL injury (odds ratio [OR] = 2.21; 95% confidence interval [CI]: 1.13-4.35; p = 0.02). Patients who underwent ACL-R with bone-patellar tendon-bone (BPTB) autograft exhibited a significantly higher prevalence of PFOA than those with HT autograft (p < 0.01). Moreover, male patients exhibited a higher association with PFOA than females in both the ACL-R (34.38% vs. 7.77%, p < 0.001) and non-surgical ACL injury groups (28.13% vs. 0.97%, p < 0.001). CONCLUSIONS: ACL-R significantly increases the likelihood of PFOA compared to non-surgical ACL treatment, especially when using BPTB autografts. Male patients demonstrated a higher association with PFOA in both groups. Targeted preventive strategies, including optimized graft selection and enhanced rehabilitation protocols, are crucial for reducing the risk of PFOA following ACL-R. LEVEL OF EVIDENCE: Level III.