Minimally Invasive Articular Surgery Unit, Istituto Ortopedico G. Pini, Milan, Italy.
Arthroscopy. 2012 Nov;28(11):1702-9. doi: 10.1016/j.arthro.2012.04.146. Epub 2012 Aug 27.
The purpose of our study was to retrospectively evaluate the outcomes after anterior cruciate ligament (ACL) reconstruction with hamstring in patients aged 50 years or older. In addition, we present, for the first time, the outcomes of a subgroup of middle-aged patients treated with double-bundle (DB) reconstruction.
Fifty patients aged 50 years or older underwent primary ACL reconstruction with hamstring. Inclusion criteria were primary ACL reconstruction in active patients. Exclusion criteria were multiligamentous injuries and a contralateral ACL-deficient knee. The mean age at surgery was 54.4 years (range, 50 to 65 years). The mean period from the initial injury to surgery was 32.6 months (range, 3 to 125 months). Of the patients, 36 underwent single-bundle (SB) ACL reconstruction and 14 underwent DB reconstruction. Patients were assessed preoperatively with physical examination (including range of motion, pivot-shift test, and instrumented knee laxity measurement), the Lysholm score, the International Knee Documentation Committee scoring system, and the Tegner activity scale. Standard radiographs were taken, and degenerative changes were graded according to the Ahlbäck radiologic classification of arthritis.
Patients were evaluated at a mean of 4.4 years (range, 2 to 7 years) after surgery. A significant improvement in knee function and symptoms was reported in most patients, with increased Lysholm, International Knee Documentation Committee, and Tegner scores (P < .001). The outcomes of clinical assessment and instrumented laxity testing were clearly improved when compared with preoperative status (P < .001). The level of osteoarthritis did not statistically increase at follow-up. No statistically significant difference could be observed between the SB and DB groups (P = not significant).
Operative treatment showed favorable outcomes in most of the ACL-reconstructed patients with regard to knee stability, osteoarthritis progression, and patient satisfaction in a cohort of subjects aged 50 years or older. Our subgroup of patients undergoing DB ACL reconstruction reported average satisfactory outcomes, which did not significantly differ from the SB group.
Level IV, therapeutic case series.
本研究旨在回顾性评估 50 岁及以上患者前交叉韧带（ACL）重建后采用腘绳肌的治疗效果。此外，我们首次报告了采用双束（DB）重建治疗的中年患者亚组的结果。
50 名 50 岁及以上的患者接受了 ACL 重建，采用腘绳肌。纳入标准为活跃患者的初次 ACL 重建。排除标准为多韧带损伤和对侧 ACL 缺失膝关节。手术时的平均年龄为 54.4 岁（范围，50 至 65 岁）。从初次损伤到手术的平均时间为 32.6 个月（范围，3 至 125 个月）。其中 36 名患者接受了单束（SB）ACL 重建，14 名患者接受了 DB 重建。患者术前接受体格检查（包括活动范围、前抽屉试验和仪器测量膝关节松弛度）、Lysholm 评分、国际膝关节文献委员会评分系统和 Tegner 活动量表评估。拍摄标准 X 线片，并根据 Ahlbäck 关节炎放射学分类对退行性改变进行分级。
患者术后平均随访 4.4 年（范围，2 至 7 年）。大多数患者报告膝关节功能和症状明显改善，Lysholm、国际膝关节文献委员会和 Tegner 评分均增加（P<0.001）。与术前相比，临床评估和仪器松弛度测试的结果明显改善（P<0.001）。随访时骨关节炎的程度并未统计学增加。SB 组和 DB 组之间无统计学差异（P=无统计学意义）。
在 50 岁及以上的 ACL 重建患者中，手术治疗在膝关节稳定性、骨关节炎进展和患者满意度方面取得了较好的结果。我们的 DB ACL 重建患者亚组报告了平均满意的结果，与 SB 组无显著差异。
IV 级，治疗性病例系列。
