急性前交叉韧带损伤非手术与手术治疗后患者报告膝关节功能及重返运动率：NACOX前瞻性队列研究结果
简介
该研究基于NACOX前瞻性多中心队列，纳入272例急性前交叉韧带（ACL）损伤患者（平均年龄25.5岁，52%为女性），比较非手术与ACL重建（ACLR）治疗后24个月的患者报告膝关节功能（IKDC-SKF）和重返运动率。结果显示，两组IKDC-SKF评分无显著差异，均随时间改善（P<0.001），但新发严重膝关节损伤、年龄较大和女性对评分有负面影响。总体重…
英文摘要
BACKGROUND: The best treatment for acute anterior cruciate ligament (ACL) injuries (surgical or nonsurgical) remains uncertain, particularly regarding return to sport (RTS) and knee function. PURPOSE: To compare patient-reported knee function (International Knee Documentation Committee Subjective Knee Form [IKDC-SKF]) and RTS between non-ACL reconstruction (ACLR) and ACLR treatment strategies 24 months after ACL injury or reconstruction and identify predictors of these outcomes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: From the NACOX multicenter cohort, 272 patients (mean age, 25.5 years; 95% CI, 24.6-26.3 years; 52% females) with acute ACL injuries were followed for 24 months after ACL injury or ACLR. Treatment (non-ACLR vs ACLR) was determined via shared decision-making in routine practice. IKDC-SKF scores were collected at 3, 6, 12, and 24 months and analyzed using a linear mixed-effects model adjusted for age, sex, preinjury activity level, and new serious knee injury. RTS was defined as return to preinjury Tegner level or higher. Risk factors for not returning to sport were evaluated using log-binomial regression. RESULTS: The ACLR group had higher preinjury Tegner levels (8 vs 6.5; P < .001) and was younger (24.2 vs 27.6 years; P < .001). No differences in IKDC-SKF scores were observed between non-ACLR and ACLR groups. IKDC-SKF scores improved over time for both groups (P < .001) but were negatively affected by new serious knee injury (P < .001), older age (P = .003), and female sex (P = .004). Overall, 75% of patients achieved RTS within 24 months (mean, 6.3 months; 95% CI, 5.6-7.0 months), with no difference between groups (72% non-ACLR vs 77% ACLR; P = .286). Patients without ACLR returned to sport earlier (3.5 months [95% CI, 2.8-4.2 months] vs 8.1 months [95% CI, 7.2-9.0 months]; P < .001). In patients aged 26 to 40 years, ACLR was associated with a 3.15-fold higher risk of not returning to sport at 24 months compared to the non-ACLR group (P = .015). CONCLUSION: In this cohort of patients with ACL injury, both nonsurgical management and ACLR, determined through shared decision-making, resulted in comparable patient-reported knee function and RTS rates at 24 months, although the ACLR group was younger and had higher activity level. Non-ACLR treatment may therefore be a viable option for selected patients, particularly those who are older or have lower activity demands, to achieve satisfactory RTS outcomes. Older age (26-40 years) was associated with a higher risk of not returning to sport after ACLR, highlighting the importance of individualized treatment decisions.