[Mid-term effectiveness of anterior cruciate ligament revision]

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Jan 15;35(1):58-63. doi: 10.7507/1002-1892.202008125.
[Article in Chinese]

Abstract

Objective: To assess the mid-term effectiveness of anterior cruciate ligament (ACL) revision and to analyze the relevant factors that may affect the surgical outcomes.

Methods: The clinical data of 24 patients who underwent ACL revision surgery between April 2009 and July 2018 and were followed up for more than 2 years were retrospectively analyzed. There were 20 males and 4 females with a median age of 30 years [interquartile distance (IQR) was (25, 36) years]. The median body mass index was 24.45 kg/m 2 and IQR was (22.93, 25.93) kg/m 2. The median time between ACL revision and reconstruction was 41 months and IQR was (15, 85) months. The direct cause of the failure of reconstruction surgery included 14 cases of trauma, 8 cases of no obvious cause, and 2 cases of infection. During the revision operation, 14 patients had a poor bone tunnel position, all of which were drilled with new tunnels, the remaining 10 patients were freshly modified on the basis of the original bone tunnel. Seventeen patients used autogenous tendon revision, 7 patients used LARS ligament; 16 patients had cartilage injury. The Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Tegner sports rating score were used for functional evaluation before operation, at 1 year after operation, and at last follow-up. The Likert satisfaction score was recorded at last follow-up.

Results: Patients were followed up with a median time of 47 months and IQR was (32, 61) months. The Lysholm score, IKDC score, and Tegner sports rating score were significantly improved at 1 year after operation and at last follow-up when compared with preoperative scores ( P<0.05). There was no significant difference between at last follow-up and at 1 year after operation ( P>0.05). At last follow-up, the median Likert satisfaction score was 4.0 and IQR was (3.0, 4.5). According to the presence or absence of cartilage damage and the type of graft, the above scores at last follow-up were compared between the groups, and the differences were not significant ( P>0.05). At last follow-up, 2 patients had graft fractures due to trauma again, and autogenous iliac bones were taken to fill the bone tunnel, and the second stage was revised; the rest of the patients recovered satisfactorily.

Conclusion: With preoperative identification of the cause of ACL reconstruction failure, the stability and function of knee joint can be significantly improved by selecting appropriate bone tunnels and grafts during the revision and by active rehabilitation exercises.

目的: 评估前交叉韧带(anterior cruciate ligament,ACL)翻修术后的中期疗效以及相关影响因素分析。.

方法: 回顾分析 2009 年 4 月—2018 年 7 月行 ACL 翻修术且术后随访 2 年以上的 24 例患者临床资料。其中男 20 例,女 4 例;年龄中位数为 30 岁,四分位数间距(interquartile distance,IQR)为(25,36)岁。体质量指数中位数为 24.45 kg/m 2,IQR 为(22.93,25.93) kg/m 2。ACL 翻修术与重建术间隔时间中位数为 41 个月,IQR 为(15,85)个月。重建术失效直接原因:外伤 14 例,无明显诱因 8 例,感染 2 例。翻修术中共 14 例患者骨隧道位置不佳,均钻取全新隧道,余 10 例在原骨隧道基础上进行新鲜化;17 例患者采用自体肌腱翻修,7 例采用 LARS 人工韧带;16 例患者合并软骨损伤。术前、术后 1 年和末次随访时采用 Lysholm 评分、国际膝关节文献委员会(IKDC)评分及 Tegner 运动等级评分进行功能评价,末次随访时记录 Likert 患者满意度评分。.

结果: 术后患者均获随访,随访时间中位数为 47 个月,IQR 为(32,61)个月。患者术后 1 年及末次随访时 Lysholm 评分、IKDC 评分、Tegner 运动等级评分均较术前明显提高( P<0.05),末次随访时与术后 1 年比较差异无统计学意义( P>0.05)。末次随访时 Likert 患者满意度评分中位数为 4.0 分,IQR 为(3.0,4.5)分。根据软骨损伤与否和移植物类型分组,组间比较末次随访时上述各评分,差异均无统计学意义( P>0.05)。末次随访时 2 例患者因外伤再次发生移植物断裂,均取自体髂骨填塞骨隧道,二期进行翻修;其余患者功能恢复满意。.

结论: ACL 翻修术前明确重建失败原因,术中选取合适的骨隧道和移植物,术后辅以积极的康复锻炼,可获得良好中期疗效。.

Keywords: Anterior cruciate ligament; arthroscopy; mid-term effectiveness; reconstruction; revision.

MeSH terms

  • Adult
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries* / surgery
  • Anterior Cruciate Ligament Reconstruction*
  • Female
  • Humans
  • Knee Joint / surgery
  • Male
  • Retrospective Studies
  • Treatment Outcome

Grant support

国家自然科学基金面上项目(81873175、81473710、82074244)