Wat is de snelheid van knieartrose 10 jaar na voorste kruisbandletsel? Een bijgewerkte systematische review

Wat is de snelheid van knieartrose 10 jaar na voorste kruisbandletsel? Een bijgewerkte systematische review

september 8, 2019 0 Door admin

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What’s the rate of knee osteoarthritis 10 years after anterior cruciate ligament injury? An updated systematic review

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  1. Marthe Mehus Lie1,
  2. May Arna Risberg2,3,
  3. Kjersti Storheim1,4,
  4. Lars Engebretsen3,5,
  5. Britt Elin Øiestad1

  1. 1 Institute of Physiotherapy, OsloMet – Oslo Metropolitan University, Oslo, Norway

  2. 2 Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway

  3. 3 Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway

  4. 4 Research and Communication unit for Musculoskeletal Health (FORMI), Oslo University Hospital, Oslo, Norway

  5. 5 Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
  1. Correspondence to Dr Britt Elin Øiestad, Institute of Physiotherapy, OsloMet – Oslo Metropolitan University, Oslo, Norway; brielo{at}oslomet.no

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Abstract

Background This updated systematic review reports data from 2009 on the prevalence, and risk factors, for knee osteoarthritis (OA) more than 10 years after anterior cruciate ligament (ACL) tear.

Methods We systematically searched five databases (PubMed, EMBASE, AMED, Cinahl and SPORTDiscus) for prospective and retrospective studies published after 1 August 2008. Studies were included if they investigated participants with ACL tear (isolated or in combination with medial collateral ligament and/or meniscal injuries) and reported symptomatic and/or radiographic OA at a minimum of 10 years postinjury. We used a modified version of the Downs and Black checklist for methodological quality assessment and narrative synthesis to report results. The study protocol was registered in PROSPERO.

Results Forty-one studies were included. Low methodological quality was revealed in over half of the studies. At inclusion, age ranged from 23 to 38 years, and at follow-up from 31 to 51 years. Sample sizes ranged from 18 to 780 participants. The reported radiographic OA prevalence varied between 0% and 100% >10 years after injury, regardless of follow-up time. The studies with low and high methodological quality reported a prevalence of radiographic OA between 0%–100% and 1%–80%, respectively. One study reported symptomatic knee OA for the tibiofemoral (TF) joint (35%), and one study reported symptomatic knee OA for the patellofemoral (PF) joint (15%). Meniscectomy was the only consistent risk factor determined from the data synthesis.

Conclusion Radiographic knee OA varied between 0% and 100% in line with our previous systematic review from 2009. Symptomatic and radiographic knee OA was differentiated in two studies only, with a reported symptomatic OA prevalence of 35% for the TF joint and 15% for PF joint. Future cohort studies need to include measurement of symptomatic knee OA in this patient group.

PROSPERO registration number CRD42016042693.

  • anterior cruciate ligament
  • knee osteoarthritis
  • risk factor

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Introduction

Anterior cruciate ligament (ACL) tears are common injuries1 with an annual incidence in the general population of 68.6 per 100 000 person-years.2 However, the incidence rates among specific sports are reported to be higher (eg, soccer, football, team handball).1 The ACL tears occur mostly in young athletes,3 and about 50% of those injured do not return to their preinjury sport activity.4 The most important consequence of an ACL tear is development of knee osteoarthritis (OA) at a relatively young age. Post-traumatic OA results in a longer period of joint-related morbidity compared with the non-traumatic OA as developed in elderly,5 and reduced quality of life is found in this group.6

In 2009, we published a systematic review on the prevalence and risk factors for radiographic knee OA after ACL tear.7 The systematic review included 7 prospective and 24 retrospective cohort studies. In the studies with the best methodological quality, that is, the seven prospective studies, 0%–13% of participants with isolated ACL tears had radiographic OA and 21%–48% of those with additional meniscus injury. Most studies were retrospective, with high quality and low quality (24 of 31 studies). Since this review, additional reviews have investigated different aspects of ACL tear and its consequences. Ajuied et al 8 found ACL tear to increase the risk of radiological knee OA [defined with the Kellgren & Lawrence (K&L) classification system] by nearly five times. Riccardo et al 9 reported mild signs of joint degeneration in 12 included studies of isolated ACL tears. Other studies investigated predictors for tibiofemoral (TF) and patellofemoral (PF) OA,10 or compared operative and non-surgical management.11–13 The lack of high-quality studies was highlighted, and caution recommended when reviewing the results. No systematic reviews reported the prevalence of symptomatic knee OA. Knee pain is the most important criteria to diagnose OA,14 and there is lack of knowledge of symptomatic OA in individuals with ACL tear. We argue that radiographic diagnosed OA alone has limited clinical interest. The aim of this study was to conduct an update of the systematic review from 2009 on the prevalence and risk factors for radiographic knee OA more than 10 years after ACL tear. In addition, we added a summary of the prevalence and risk factors for symptomatic knee OA more than 10 years after ACL tear.

Methods

We reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.15 This systematic review is an update of a previous systematic review with the same inclusion and exclusion criteria. We included only new data from 1 August 2008 to 1 August 2018 in this study.

Study selection

The inclusion criteria were: prospective or retrospective cohort study designs, participants with ACL tear treated surgically or non-surgically, isolated ACL tear or ACL tear combined with meniscal and/or medial collateral ligament tear, radiographic assessment as one of the outcomes, a follow-up time of a minimum 10 years, studies published after 1 August 2008, and studies reported in English or Scandinavian languages. The exclusion criteria were: studies on skeletally immature participants, and animal studies. If several cohort studies appeared to be from the same study sample, we included the study that was most relevant according to our research question with emphasis on the prevalence of radiographic and symptomatic OA, and risk factors for OA.

Data sources and searches

Systematic searches were performed until 1 August 2018 in five different databases by two of the authors (MML and BEØ): PubMed, EMBASE, Cinahl, AMED and SPORTDiscus. A librarian at the Oslo Metropolitan University helped building up the systematic searches. The search strategy for the databases is presented in online supplementary appendix 1. Additionally, we hand searched for relevant published papers in recent systematic reviews, the included studies reference list and other relevant studies.

Data extraction

Two authors (MML and BEØ) extracted the study characteristics, including: type of study, number of participants at start and follow-up, age, sex, type of treatment, concomitant injuries, reinjuries, the knee compartment investigated, the prevalence of symptomatic and radiographic OA, the radiological classification system used, and the radiological method. In cases where studies reported raw data for the radiographic outcome, we based the extracted data on the specified radiological classifications systems’ cut-off values. Reported risk factors were extracted from all studies that used regression analysis.

Study methodological quality assessment

Four of the authors (MML, LE, KS and MAR) independently assessed the study quality according to guidelines from the Centre of Reviews and Dissemination,16 and questions from the Downs and Black checklist.17 The checklist was modified and operationalised for the purpose of this systematic review. Each component of study quality was rated with YES (1 point), NO (0 points) or UNCLEAR (0 points). Studies with a score ≥8 (>60% of the maximal attainable score) were classified as high quality according to another systematic review from our group.18 Two authors scored the studies independently, and then the scores were compared (MML and LE; MML and KS; MML and MAR). In cases of disagreement, the authors tried to achieve consensus. If consensus was not reached, a third author (BEØ) gave a final judgement.

Data synthesis

The large heterogeneity in the reporting of outcomes in the included studies precluded meta-analysis. We used narrative synthesis to investigate and report similarities, differences and results between the included studies.19 20 The results from this update were discussed against the results from the systematic review from 2009.

Results

Identification and selection of the literature

The systematic searches identified 1853 new studies from 1 August 2008. After removing duplicates, 1712 studies were screened by title and/or abstract. A total of 57 studies were considered as eligible and were read in full-text. Of these, 16 studies were excluded, as they did not fulfil our inclusion and/or exclusion criteria. Finally, 41 studies were included in this systematic review (figure 1). Of these, 23 had a prospective study design,21–42 and 18 had a retrospective study design.43–60

Figure 1

Flow diagram. OA, osteoarthritis.

Excluded studies

We were not able to extract the OA prevalence from five studies.58 61–64 The respective authors were contacted by mail in an attempt to receive the data, and one author responded.58 The systematic searches identified 16 studies using data from the same cohort.27 28 32 36 41 42 54 65–73 We excluded eight of these66–73 to avoid reporting OA prevalence from the same cohort. In the study by Holm et al 42 we only extracted the PF OA prevalence as the TF OA prevalence data was reported in the study by Øiestad et al.27

Description of the included studies

The characteristics of the included studies are presented in online supplementary table 1. A total of 4919 participants were included, and sample sizes ranged from 18 to 780 participants. The male and female sample sizes varied from 7 to 106 and 0 to 109, respectively. Age at inclusion ranged from 23 to 38 years (28.1±3), and age at follow-up ranged from 31 to 51 (42.2±5) years. A total of 4709 participants (96%) were treated surgically, and 210 (4%) were treated non-surgically. Thirty-five studies evaluated surgically treated participants only,21–30 32 34 35 38–46 48–53 55–60 65 and six studies evaluated both surgically and non-surgically treated participants.31 33 36 37 47 54 Twelve studies21 27 28 37 39 40 42 45–48 53 reported OA results for the contralateral knee, involving 833 knees. Eighteen studies used bone-patellar-tendon-bone (BPTB) graft,23 28–30 32 36–38 42–44 47 48 51 53 54 56 57 12 used hamstring tendon (HT) graft,22 24 25 33 39 41 46 49 50 52 58 60 seven studies included both BPTB and HT graft,21 26 27 35 45 59 65 two studies used synthetic graft,34 55 and one study used HT and synthetic graft.40 One study did not report the type of graft.31 The follow-up time ranged from 10 to 24 years, with a mean follow-up time of 13.7 years.

Methodological quality

Online supplementary table 2 shows the methodological quality assessments. The lowest score achieved was 3, and the highest was 11. Nineteen studies (46%) achieved a score ≥8 and were considered to have high quality. The prospective studies achieved a mean score of 7.8 with a highest score of 11 and a lowest score of 3. The retrospective studies achieved a mean score of 6.7 with a highest score of 11 and a lowest score of 3. In 3.6% of the questions the authors could not reach consensus regarding the score, and the third author (BEØ) gave final judgement. Twenty-seven studies21–23 31–37 39–41 44–46 48 49 51–55 57 58 60 65 did not fulfil the criteria for confounding factors, 30 studies21–23 25–27 29–36 38 40 42 45 48 50–58 60 65 did not fulfil the criteria of appropriate sample size calculation and drop-out rates, and 22 studies23 25 29 30 34–36 38 43 44 49–59 65 73 did not fulfil the criteria for description of qualified radiologist in the Method section. In total, 12 studies23 34–36 51–55 57 58 65 failed to report both confounding factors, sample size calculation and drop-out rate, and had no information on qualified radiologist was included in the outcome assessment.

Prevalence of radiographic OA

The prevalence of radiographic OA in the TF joint ranged from 0% to 100% (online supplementary table 3). The retrospective and prospective studies reported a prevalence of radiographic knee OA between 0%–79% and 0%–100%, respectively. The high-quality and low-quality studies reported a prevalence of radiographic knee OA between 1%–80% and 0%–100%, respectively. Fourteen of the included studies22 23 25 28 31 32 36 38 39 42 43 49 59 60 reported radiographic OA prevalence for the PF joint, ranging from 0% to 41%. Of these, one study28 reported and investigated the prevalence of radiographic OA in the PF joint solely (26%). Six studies31 33 36 37 47 54 reported OA prevalence for surgically and non-surgically treated participants, which varied from 23% to 80% and 8% to 68%, respectively. Participants treated with BPTB graft had OA prevalence varying between 2% and 80%, and participants treated with HT graft had OA prevalence varying between 0% and 73%. Three studies34 40 55 investigated OA prevalence in participants treated with synthetic graft, showing an OA prevalence of 39%, 50% and 100%. Figure 2 illustrates the radiographic OA prevalence for the range of follow-up time.

Figure 2

Illustration of radiographic osteoarthritis prevalence. ACL, anterior cruciate ligament.

Eleven of the included studies21 27 28 37 39 40 45–48 53 reported radiographic OA prevalence in the contralateral knee, ranging from 2% to 38%. Of these, five studies reported results from uninjured contralateral knees,27 28 45 48 53 four studies21 39 40 42 reported additional injuries to the contralateral knee (ACL injury, chondral lesion, meniscal injury, medial collateral ligament and lateral collateral ligament injury), while three studies37 46 47 did not provide any information regarding additional injuries to the contralateral knee.

Prevalence of symptomatic OA

Two studies evaluated the prevalence of symptomatic knee OA.27 28 Of these, one study27 reported a 35% symptomatic OA prevalence for the TF joint, and one28 study reported a 15% symptomatic OA prevalence for the PF joint (figure 3).

Figure 3

Comparison of symptomatic and radiographic knee osteoarthritis.

Risk factors for the development of knee OA

A total of 26 studies reported risk factors, and all but one study23 used statistical analysis for identification of risk factors. Twelve studies investigated risk factors by regression analysis,22 24 26–30 32 38 43 50 59 and three reported adjustment for confounding variables.27 28 30 Of these three, two27 30 studies reported risk factors for radiographic knee OA, one study27 investigated risk factors for symptomatic knee OA and one study28 investigated risk factors for PF OA.

Risk factors for radiographic OA

The reported risk factors for radiographic TF OA were increased age at surgery, additional injury, range of motion loss at final follow-up, partial medial meniscectomy and articular cartilage damage. For PF OA, the reported risk factors were increased age, TF OA, impaired knee function, more symptoms, pain during activity and kneeling pain.

The variables reported as non-significant risk factors for TF OA were quadriceps muscle weakness measured in absolute values (joules) or absolute values normalised to bodyweight (%BW), functional tests and removal of lateral meniscus. For PF OA the variables reported as non-significant were knee laxity, self-reported knee function, quadriceps strength and hop test up to 2 years postoperatively.

Risk factors for symptomatic OA

The reported risk factors for symptomatic knee OA were impaired self-reported knee function 2 years postoperatively and loss of quadriceps strength between 2 and 10–15 years. Non-significant risk factors for symptomatic knee OA were quadriceps muscle weakness measured in absolute values (joules) or absolute values normalised to bodyweight (%BW) and functional tests. Online supplementary appendix 2 shows the results for the reported risk factors for all 12 studies using regression analysis.

Discussion

This updated systematic review found that knee OA prevalence varied from 0% to 100%. We identified 41 new studies from 2008 investigating 4919 individuals with ACL tear with a mean follow-up time of 13.7 years. Low methodological quality was revealed among more than half of the studies. In the present review we also investigated the prevalence of symptomatic knee OA, and found it to be 35% for the TF joint and 15% for the PF joint.

The reported prevalence of radiographic OA varied between 0% and 100%, regardless of follow-up time as shown in figure 2, which is consistent with the reported prevalence from the previous systematic review from 2009. In three of the 41 studies, the participants had isolated ACL injury at study start, but at follow-up all 41 studies reported additional injuries. Importantly, the majority of the studies did not concretise how many of the participants who had an additional injury or not, and none of the included studies reported radiographic and/or symptomatic OA prevalence only for participants with isolated ACL tears at follow-up. In the review from 2009, eight studies reported OA prevalence for knees with isolated ACL tear with a prevalence varying between 0% and 13%, contrary to 21%–48% in combined ACL injuries.7 The lower OA prevalence reported in isolated ACL tears indicates that the additional injuries occurring at the time of ACL tear, and/or subsequently may be an important contributor to OA development,74 as is also supported by others.9

Radiographic OA was described in 2%–38% of contralateral knees (from 12 studies). This indicates a higher OA prevalence in the contralateral knee compared with the global age-standardised prevalence, which is reported to be 3.8%.75 An ACL tear may cause bilateral movement responses, leading to proprioceptive deficits in the healthy knee from the ACL injured knee.76–78 Such adaptations may predispose the contralateral knee to overuse and result in premature OA development, compared with the general population. As knee OA is a complex interaction affected by multiple factors, one cannot rule out the possibility that heavy physical work, kneeling, crawling, repetitive movements and/or genetics79 80 have contributed to the higher occurrence of OA in the contralateral knee as seen in this systematic review.

PF radiographic OA prevalence ranged between 0% and 41%. Hart et al 81 reported structural damage from MRIs of the PF joint, with a prevalence of 29% in ACL injured or reconstructed participants. Although K&L, The International Knee Documentation Committee (IKDC) and The Osteoarthritis Research Society International (OARSI) are commonly used to quantify the severity of PF OA, neither of these radiological classification systems have validated definitions of the PF joint, which likely may explain some of the variation in the results.81 82 More studies are needed to evaluate the different radiological classification systems ability to detect degenerative changes in the PF joint to get a better understanding of PF OA.

OA prevalence >10 years post-ACL tear was not different in those treated surgically (8%–68%) compared with non-surgically (24%–80%), which indicates little difference in OA development between treatment options. The findings are in line with a randomised controlled trial study by Frobell et al 83 who reported no difference between surgically and non-surgically treated participants at 5-year follow-up. This is confirmed by recent systematic reviews and meta-analyses, but no RCT studies were included in these reviews.11–13 Studies have shown that ACL reconstruction is not a prophylactic treatment in the development of OA,84 85 which may explain the small differences between treatment options. Similarly, no new knowledge about the influence of graft type can be extracted from this review, also in line with findings from other studies.86–88

Symptomatic knee OA prevalence was reported in two included studies only. One study27 investigated the TF joint, and one study28 investigated the PF joint with a reported prevalence of 35% and 15%, respectively. In these two studies, approximately half of those who were diagnosed with radiographic knee OA had symptomatic knee OA. A number of authors have highlighted the poor correlation between radiologically determined OA and pain,89–93 but very few studies have investigated the prevalence of symptomatic knee OA following ACL tear. Suter et al function gtElInit() { var lib = new google.translate.TranslateService(); lib.setCheckVisibility(false); lib.translatePage(‘en’, ‘nl’, function (progress, done, error) { if (progress == 100 || done || error) { document.getElementById(“gt-dt-spinner”).style.display = “none”; } }); } a href = “# ref-94” id = “xref-ref-94-1″> 94 schatte dat het levenslange risico op symptomatische knie-artrose na ACL en meniscusscheuren 34% was, wat vergelijkbaar is met onze bevindingen voor het TF-gewricht. Ook Lohmander et al 95 meldde 42% symptomatische radiografische knie-OA bij vrouwelijke voetballers 12 jaar na ACL-traan, vergelijkbaar met de andere studies van symptomatische knie-OA na ACL-traan. Jones et al 96 vergeleek deelnemers met vroege en geavanceerde structurele veranderingen in het TF-gewricht. Hun resultaten toonden aan dat de ernst van de gerapporteerde pijn vergelijkbaar was tussen de groepen, wat suggereert dat de mate van radiologische veranderingen niet overeenkomt met de ernst van de pijn. De reden voor de zwakke correlatie tussen radiografische bevindingen en pijn is nog steeds niet helemaal duidelijk. 92 93 97

Risicofactoren voor de ontwikkeling van knie-OA

Twaalf van de opgenomen onderzoeken hebben een grondige analyse van risicofactoren uitgevoerd voor OA. Negen hiervan rapporteerden niet als ze rekening hadden gehouden met verwarrende variabelen, wat het vertrouwen in de resultaten vermindert. Soortgelijke bevindingen werden gerapporteerd in een systematische review door van Meer et al 10 die de afwezigheid van geschikte analytische benaderingen benadrukte. Een gevolg van onvoldoende geplande studies is dat de onderzochte risicofactoren te wijten zijn aan toeval. Niet corrigeren voor verwarrende variabelen kan leiden tot fout-positieve resultaten, omdat de gerapporteerde bevindingen mogelijk het gevolg zijn van andere onderliggende factoren.

In totaal hebben drie van de opgenomen onderzoeken een multivariate regressieanalyse aangepast voor confounding variabelen. Meniscectomie was de enige consistente risicofactor voor radiografische artrose in verschillende onderzoeken. Meniscusletsel, vaak behandeld door meniscectomie, is de meest onderzochte en gedocumenteerde risicofactor en komt voor bij ongeveer 75% van de deelnemers met ACL-letsel. 98 De menisci zorgen voor stabiliteit in het TF-gewricht, verdeelt belasting, absorbeert schokken, smeert het kniegewricht en beschermt het gewrichtskraakbeen tegen overmatige axiale belasting. 99 100 Bij beschadiging neemt de axiale belasting op het gewrichtskraakbeen toe, waardoor het risico op OA-ontwikkeling vatbaar wordt en wordt verhoogd. 9 100 Studies hebben een sterke correlatie aangetoond tussen meniscuslaesies, kraakbeenverlies en subchondrale beenmergletsels die belangrijke factoren zijn bij de ontwikkeling van artrose. 101 In de huidige beoordeling werden meniscusletsel vaak gemeld bij het eerste ACL-letsel of tijdens de follow-upperiode, wat de verhoogde OA-prevalentie kan verklaren die we rapporteren vergeleken met wi th geïsoleerde ACL-blessures. 9

Naast meniscectomie, verhoogde leeftijd bij chirurgie, bereik van bewegingsverlies bij laatste follow-up en articulaire kraakbeenschade werden gerapporteerd als risicofactoren voor radiografische knie OA. Twee van de opgenomen onderzoeken meldden dat spierzwakte in quadriceps geen significante risicofactor was voor de ontwikkeling van knie-OA, 27 28 maar eerdere systematische reviews hebben tegenstrijdige conclusies opgeleverd met betrekking tot deze associatie. 18 102 De gerapporteerde risicofactoren zijn in overeenstemming met andere bevindingen, 10 103 maar voeg geen nieuw inzicht toe of vergroot het inzicht in de ontwikkeling van OA niet. We suggereren dat multivariate regressieanalyse moet worden gebruikt in toekomstige multicenter prospectieve cohortstudies met frequente follow-ups om risicofactoren voor de ontwikkeling van symptomatische knie-OA te onderzoeken, 104 en studies moeten onderscheid maken tussen radiografische en symptomatische artrose om deze associatie grondig te verkennen.

Methodologische kwaliteitsbeoordeling h3>

Over het geheel genomen betekenden de 41 opgenomen studies dat de methodologische kwaliteitsscore 7,2 van de 12 was (bereik 3-11). Onze review onthulde kleine verschillen in de gerapporteerde OA-prevalentie tussen de studies van hoge kwaliteit en van lage kwaliteit. Dit komt niet overeen met de bevindingen uit de review van 2009, 7 waar de hoogwaardige onderzoeken een lagere OA-prevalentie rapporteerden. Opgemerkt moet worden dat we verschillende checklists hebben gebruikt en dat de resultaten daarom niet direct kunnen worden vergeleken. In tegenstelling tot de beoordeling in 2009 hebben we geen onderscheid gemaakt tussen onderzoeksopzet in de kwaliteitsbeoordeling, wat het kleine verschil tussen de prospectieve en retrospectieve studies kan verklaren.

In de literatuur is er geen consensus over hoge of lage methodologische kwaliteit en het evalueren van studies vanuit dit perspectief kan problematisch zijn. 16 We hebben ervoor gekozen om onderscheid te maken tussen hoge en lage kwaliteit in lijn met een ander vergelijkbaar artikel, met een cut-off score van > 60%, wat in dit geval een score was van > 8. 18 De resultaten zijn alleen geldig voor deze systematische review en mogen niet direct worden overgedragen aan andere contexten of worden geïnterpreteerd als de waarheid.

Een zwakte van onze kwaliteitsbeoordeling was dat we geen onderscheid maakten tussen de impact van bepaalde vragen. Gebrek aan het voldoen aan de criteria voor vraag nummer 5, 7, 9 en 12 kan van groter belang zijn voor de methodologische kwaliteit, aangezien deze vragen de rapportage van confoundable variabelen, de kracht van de studie, validiteit en betrouwbaarheid van de uitkomstmaten onderzoeken, en de betrouwbaarheid van de radiografische lezers. Veel van onze resultaten voldeden niet aan deze criteria. Bijgevolg zijn de gerapporteerde resultaten van deze onderzoeken mogelijk van mindere kwaliteit en moeten ze voorzichtig worden bekeken.

Beperkingen

Deze systematische review heeft enkele beperkingen. De studies waren heterogeen, wat een meta-analyse uitsluit. We hebben alleen studies opgenomen die zijn geschreven in het Engels of Scandinavisch. Niet alle onderzoeken hadden een hoofddoel om de prevalentie van artrose te evalueren. De methodologische kwaliteitsbeoordeling heeft geen gouden standaard en moet zorgvuldig worden geïnterpreteerd. We hebben geprobeerd ontbrekende OA-gegevens op te halen, maar leggen alleen contact met de auteurs van één onderzoek. Er is geen consensus over het definiëren van symptomatische knie-artrose in de literatuur, en de twee onderzoeken in deze review definieerden symptomatische artrose als K&L> 2 en rapporteerden pijn op de meeste dagen in de laatste maand vóór de beoordeling. Twee van de opgenomen studies gebruikten de hoogste grenswaarde van het radiografische scoresysteem om symptomatische knieartrose te definiëren. We hebben ervoor gekozen om deze bevindingen niet te rapporteren, omdat men niet kan aannemen dat mensen met de slechtere radiologische beoordeling automatisch overeenkomen met pijn en symptomen. Ten slotte hebben we geen gegevens uit ons onderzoek uit 2009 in deze update opgenomen omdat we de resultaten beschrijvend hebben gerapporteerd en omdat het samenvoegen van de onderzoeken onze beschrijvende resultaten niet zou veranderen.

Conclusie

Minimaal 10 jaar na een ACL-traan varieerde de gerapporteerde prevalentie van radiografische knie-OA tussen 0% en 100 %. Twee studies onderzochten symptomatische knieartrose, met een prevalentie van 35% voor het TF-gewricht en 15% voor het PF-gewricht. Meniscectomie is een belangrijke risicofactor voor de ontwikkeling van artrose. Op basis van onze resultaten kunnen geen definitieve conclusies worden getrokken uit niet-significante risicofactoren. Meer hoogwaardige studies zijn vereist om de werkelijke prevalentie van knie-artrose na ACL-letsels te detecteren. Er is een sterke behoefte aan studies die symptomatische en radiografische knie-OA differentiëren. Symptomatische knie-artrose is van hoge klinische relevantie en is de reden waarom mensen naar gezondheidszorg zoeken.

Wat is er al bekend

  • De prevalentie van knieartrose (OA) bij personen met letsel aan de voorste kruisband (ACL) varieert tussen 0% en 13 % voor geïsoleerd letsel en tussen 21% en 43% voor gecombineerd ACL- en meniscaal letsel meer dan 10 jaar na het letsel.

  • Meniscectomie is de belangrijkste risicofactor voor de ontwikkeling van knie-OA na ACL-letsel.

Wat zijn de nieuwe bevindingen

  • Zeer weinig studies hebben onderscheid gemaakt tussen symptomatische en radiografische knie-OA bij ACL-gewonden.

  • De prevalentie van symptomatische knie-OA was 35% voor de tibiofemoraal gewricht en 15% voor het patellofemoraal gewricht meer dan 10 jaar na A CL-letsel.

  • De gerapporteerde prevalentie van radiografische knie-OA varieert tussen 0% en 100%, ongeacht -up tijd.

  • Er is nog steeds een onvoldoende aantal studies van hoge kwaliteit die duidelijk de prevalentie van knie aangeven OA na ACL-letsel.

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