前交叉韧带损伤后重建不降低骨关节炎风险但降低全膝关节置换率：系统综述与Meta分析
简介
本研究为系统综述与Meta分析，纳入18项研究共33,540例ACL损伤患者（平均随访12.3年），比较手术与非手术治疗后的长期影像学骨关节炎（OA）发生率。结果显示，ACL重建组与保守治疗组的影像学OA风险无显著差异（RR=1.01），但ACL重建显著降低了全膝关节置换术（TKA）率（RR=0.17）。提示ACL重建虽不能降低远期OA风险，但可能通过维持关…
英文摘要
BACKGROUND: An anterior cruciate ligament (ACL) rupture is a common and debilitating knee injury. Although surgical management restores knee stability, its effectiveness in preventing long-term joint degeneration compared with nonoperative management remains unclear. PURPOSE/HYPOTHESIS: The purpose of this study was to compare the long-term incidence of radiographic knee osteoarthritis (OA) after the operative versus nonoperative management of ACL injuries. It was hypothesized that operative management would lead to lower rates of OA. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 3. METHODS: A systematic review and meta-analysis were conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, Embase, and Scopus were searched through June 2025 for comparative studies evaluating the development of OA after an ACL injury that was treated with operative or nonoperative management. Radiographic OA was defined as Kellgren-Lawrence grade ≥2 or equivalent. Random-effects meta-analyses were performed to compare radiographic OA, secondary meniscal surgery, and total knee arthroplasty (TKA) rates between treatment groups. Study quality was assessed using the MINORS (Methodological Index for Non-Randomized Studies) instrument and the Cochrane RoB 2 (risk of bias tool). The certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework. RESULTS: A total of 18 studies comprising 33,540 patients (mean follow-up, 12.3 years) were included. A meta-analysis of 15 studies found no significant difference in radiographic OA between the ACL reconstruction (ACLR) and nonoperative groups (risk ratio [RR], 1.01 [95% CI, 0.79-1.27]; I 2 = 92%; P = .96). A sensitivity analysis of level 1 to 2 studies with low heterogeneity yielded similar findings (RR, 1.14 [95% CI, 0.87-1.48]; I 2 = 34%; P = .33). A meta-analysis of 2 studies assessing OA prevalence in the ACL repair versus nonoperative group also found no statistically significant difference, with moderate heterogeneity (RR, 0.78 [95% CI, 0.54-1.12]; I 2 = 55%; P = .18). Rates of secondary meniscal surgery did not differ significantly (RR, 0.79 [95% CI, 0.52-1.21]; I 2 = 56%; P = .29). However, ACLR significantly reduced the risk of TKA (RR, 0.17 [95% CI, 0.07-0.43]; I 2 = 59%; P = < .001). CONCLUSION: The operative management of ACL injuries did not decrease the long-term risk of developing radiographic OA compared with nonoperative management. ACLR was associated with a lower rate of TKA.