Salmon Lucy, Russell Vivianne, Musgrove Tim, Pinczewski Leo, Refshauge Kathryn
Australian Institute of Musculoskeletal Research and The School of Physiotherapy, University of Sydney, Sydney, Australia.
Arthroscopy. 2005 Aug;21(8):948-57. doi: 10.1016/j.arthro.2005.04.110.
The aim of this study was to determine the rates of contralateral anterior cruciate ligament (ACL) rupture and of ACL graft rupture after ACL reconstruction using either patellar tendon or hamstring tendon autograft, and to identify any patient characteristics that may increase this risk.
Case series.
Over a 2-year period, 760 endoscopic ACL reconstructions were performed in 743 patients. Bone-patellar tendon-bone autograft was used in 316 patients and 4-strand hamstring tendon in 427 patients. Those patients with a previous contralateral ACL rupture or those who underwent a simultaneous bilateral ACL reconstruction were excluded, leaving 675 knees (675 patients) for review. Persons not involved in the index operation or the care of the patient conducted follow-up assessment by telephone interview conducted 5 years after surgery. Patients were questioned about the incidence of ACL graft rupture, contralateral ACL rupture, symptoms of instability or significant injury, family history of ACL injury, and activity level according to the International Knee Documentation Committee scale. From our prospective database we obtained further information on graft source, meniscal or articular surface injury, and gender. Binary logistic regression was used to measure the relative association between the measured variables and the risk of graft rupture and contralateral ACL rupture.
Five years after primary ACL reconstruction, 612 of the 675 patients (90.7%) were assessed. ACL graft rupture occurred in 39 patients (6%) and contralateral ACL rupture occurred in 35 patients (6%). Three patients suffered both a graft rupture and a contralateral ACL injury. The odds of ACL graft rupture were increased 3-fold by a contact mechanism of initial injury. Return to level 1 or 2 sports increased the risk of contralateral ACL injury by a factor of 10. The risk of sustaining an ACL graft rupture was greatest in the first 12 months after reconstruction. No other studied variable increased the risk of repeat ACL injury.
After reconstruction, repeat ACL injury occurred in 12% of patients over 5 years. Twelve months after reconstruction, the ACL graft is at no greater risk than the contralateral ACL, suggesting that adequate graft and muscular function for most activities is achieved by this time. Risk factors for repeat ACL injury identified included a return to competitive side-stepping, pivoting, or jumping sports, and the contact mechanism of the index injury. Female patients were at no greater risk of repeat ACL injury than male patients and graft choice did not affect the rate of repeat ACL injury.
Level IV, case series.
本研究旨在确定使用髌腱或腘绳肌腱自体移植进行前交叉韧带（ACL）重建术后对侧ACL断裂和ACL移植物断裂的发生率，并确定可能增加此风险的患者特征。
病例系列研究。
在2年期间，对743例患者进行了760例关节镜下ACL重建术。316例患者使用骨-髌腱-骨自体移植物，427例患者使用4股腘绳肌腱。排除既往有对侧ACL断裂或同期进行双侧ACL重建的患者，共675例膝关节（675例患者）纳入回顾分析。由未参与初次手术或患者护理的人员在术后5年通过电话访谈进行随访评估。询问患者ACL移植物断裂、对侧ACL断裂、不稳定或严重损伤症状、ACL损伤家族史以及根据国际膝关节文献委员会量表评估的活动水平。从我们的前瞻性数据库中获取有关移植物来源、半月板或关节面损伤以及性别的进一步信息。采用二元逻辑回归分析测量所测变量与移植物断裂和对侧ACL断裂风险之间的相对关联。
初次ACL重建术后5年，675例患者中的612例（90.7%）接受了评估。39例患者（6%）发生ACL移植物断裂，35例患者（6%）发生对侧ACL断裂。3例患者同时发生移植物断裂和对侧ACL损伤。初次损伤的接触机制使ACL移植物断裂的几率增加3倍。恢复到1级或2级运动使对侧ACL损伤的风险增加10倍。ACL移植物断裂的风险在重建后的前12个月最高。其他研究变量均未增加再次ACL损伤的风险。
重建术后，5年内12%的患者发生再次ACL损伤。重建术后12个月，ACL移植物的风险并不高于对侧ACL，这表明此时大多数活动已具备足够的移植物和肌肉功能。确定的再次ACL损伤的危险因素包括恢复到有竞争性的侧步、旋转或跳跃运动，以及初次损伤的接触机制。女性患者再次ACL损伤的风险并不高于男性患者，移植物的选择也不影响再次ACL损伤的发生率。
IV级，病例系列研究。
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