No abstract

Case series, Level IV.

Case series, level IV.

Background: Few studies have investigated the outcome ≥20 years after an anterior cruciate ligament reconstruction (ACLR) with a bone–patellar tendon–bone autograft, and there is a wide range in the reported rates of radiographic osteoarthritis (OA). Purpose: To report on radiographic OA development and to assess risk factors of knee OA at a median 25 years after ACLR with a bone–patellar tendon–bone autograft. Study Design: Case-control study; Level of evidence, 3. Methods: Unilateral ACLRs performed at a single center from 1987 to 1994 were included (N = 235). The study population was followed prospectively with clinical testing and questionnaires. Results from the 3-month, 12-month, and median 25-year follow-up are presented. In addition, a radiographic evaluation was performed at the final follow-up. Radiographic OA was defined as Kellgren-Lawrence grade ≥2 or having undergone ipsilateral knee replacement surgery. Possible predictors of OA development included patient age, sex, time from injury to surgery, use of a Kennedy ligament augmentation device, any concomitant meniscal surgery, and return to preinjury sports after surgery. Results: At long-term follow-up, 60% (141/235) of patients had radiographic OA in the involved knee and 18% (40/227) in the contralateral knee ( P < .001). Increased age at surgery, male sex, increased time between injury and surgery, a Kennedy ligament augmentation device, and medial and lateral meniscal surgery were significant predictors of OA development in univariate analyses. Return to preinjury level of sports after surgery was associated with less development of OA. In the multivariate model, medial meniscal surgery and lateral meniscal surgery were independently associated with OA development. The adjusted odds ratio was 1.88 (95% CI, 1.03-3.43; P = .041) for medial meniscal surgery and 1.96 (95% CI, 1.05-3.67; P = .035) for lateral meniscal surgery. Patients who had developed radiographic signs of OA had significantly lower Knee injury and Osteoarthritis Outcome Score and Lysholm scores at long-term follow-up. Conclusion: At 25 years after ACLR, 60% of patients had developed OA in the involved knee, and these patients reported significantly lower subjective outcomes. Medial meniscal surgery and lateral meniscal surgery were independent predictors of OA development at long-term follow-up.

Anagha P. Parkar er overlege ved Radiologisk avdeling, Haraldsplass Diakonale Sykehus.Ingen av forfa erne har oppgi noen interessekonflikter.Det var med stor interesse vi leste innlegget «Kunstig intelligens i klinikken -en industri uten råvarer» i Tidsskriftet nr. 10 (1).Vi er helt enig med forfa erne om at vi trenger en helhetlig regulering av helsedata. Det er holdningene som ligger bak vi er dypt uenige i.

MEDISINEN I BILDER Medisinen i bilder Cerebral amyloid angiopati2 025 Cerebral amyloid angiopati (CAA) forårsakes av amyloide avleiringer i de leptomeningeale og kortikale kar i cerebrum og cerebellum. Sykdommen er ikke relatert til systemisk amyloidose. Avleiringene fører til fibrinoid nekrose og mikroaneurismer i affiserte kar. Ruptur av aneurismer gir mikroog makroblødninger. Insidensen stiger med økende alder. Slik angiopati er en viktig årsak til hjerneblødning hos eldre. Mikroblødninger kan føre til residiverende episoder med transitoriske nevrologiske utfall. Blødningene etterlater hemosiderinavleiringer kortikalt-subkortikalt. Disse visualiseres ikke på CT og er vanskelig å se på vanlige MR-bilder. Bildet til venstre viser en mulig avleiring på venstre side, markert med pil, som ble tolket som uspesifikk, ellers normale funn. Symptomene mistolkes ofte