前交叉韧带重建术后的结果与风险因素：948例患者的随访研究

Outcome and risk factors after anterior cruciate ligament reconstruction: a follow-up study of 948 patients.

作者信息

Laxdal Gauti, Kartus Jüri, Ejerhed Lars, Sernert Ninni, Magnusson Lennart, Faxén Eva, Karlsson Jon

机构信息

Department of Orthopaedics, Sahlgrenska University Hospital , Göteborg, Sweden.

出版信息

Arthroscopy. 2005 Aug;21(8):958-64. doi: 10.1016/j.arthro.2005.05.007.

DOI:10.1016/j.arthro.2005.05.007

PMID:16084293

Abstract

PURPOSE

The aim of the study was to assess the outcome and risk factors after anterior cruciate ligament (ACL) reconstruction in a large group of patients.

TYPE OF STUDY

Case series.

METHODS

Included in this retrospective study were 948 patients (323 female, 625 male) with a symptomatic unilateral ACL rupture, who underwent arthroscopic reconstruction using patellar tendon autograft and interference screw fixation at 3 Swedish hospitals. The median age of the patients at the time of the index operation was 26 years (range, 14 to 53 years). The patients underwent surgery at a median of 12 months (range, 0.5 to 360 months) after their injury. Independent physiotherapists performed the follow-up examinations at a median of 32 months (range, 21 to 117 months) postoperatively.

RESULTS

Of the 948 patients, 550 (58%) underwent meniscal surgery before, during, or after the ACL reconstruction. The median Tegner activity level was 8 (range, 2-10) before injury, 3 (range, 0-9) preoperatively, and 6 (range, 1-10) at follow-up (P < .0001 preoperative v follow-up). At follow-up, the median Lysholm score was 90 points (range, 14-100), the median KT-1000 anterior side-to-side laxity difference was 1.5 mm (range, -6 to 13 mm), and the median 1-leg hop test quotient was 95% (0% to 167%) compared with the contralateral normal side. At follow-up, 69.3% of the patients were classified as normal or nearly normal according to the International Knee Documentation Committee evaluation system. However, 36% of the patients were unable to or had severe problems performing the knee-walking test. Inferior results correlated with increased time period between the index injury and reconstruction and concomitant joint damage found at the index operation.

CONCLUSIONS

Overall, the results were good after ACL reconstruction using patellar tendon autograft and interference screw fixation. Concomitant joint damage and a long time period between the injury and reconstruction are major risk factors for inferior outcome after ACL reconstruction.

LEVEL OF EVIDENCE

Level IV, case series.

摘要

目的

本研究旨在评估一大组患者前交叉韧带（ACL）重建后的结果及危险因素。

研究类型

病例系列。

方法

本回顾性研究纳入了948例有症状的单侧ACL断裂患者（323例女性，625例男性），这些患者在瑞典的3家医院接受了关节镜下髌腱自体移植和挤压螺钉固定重建手术。初次手术时患者的中位年龄为26岁（范围14至53岁）。患者在受伤后中位12个月（范围0.5至360个月）接受手术。独立的物理治疗师在术后中位32个月（范围21至117个月）进行随访检查。

结果

948例患者中，550例（58%）在ACL重建之前、期间或之后接受了半月板手术。受伤前Tegner活动水平中位数为8（范围2至10），术前为3（范围0至9），随访时为6（范围1至10）（术前与随访相比，P <.0001）。随访时，Lysholm评分中位数为90分（范围14至100），KT-1000前后侧松弛度差异中位数为1.5 mm（范围 -6至13 mm），单腿跳测试商数与对侧正常侧相比中位数为95%（0%至167%）。根据国际膝关节文献委员会评估系统，随访时69.3%的患者被分类为正常或接近正常。然而，36%的患者无法进行或在进行膝关节行走测试时有严重问题。结果较差与初次受伤至重建的时间间隔延长以及初次手术时发现的合并关节损伤相关。