Kate E. Webster, School of Allied Health, Faculty of Health Sciences, La Trobe University, Victoria 3086, Australia.
Am J Sports Med. 2014 Mar;42(3):641-7. doi: 10.1177/0363546513517540. Epub 2014 Jan 22.
Graft rupture of the same knee or injury to the anterior cruciate ligament (ACL) in the contralateral knee is a devastating outcome after ACL reconstruction surgery. While a number of factors have been identified as potentially increasing the risk of subsequent ACL injury, the literature is far from definitive.
To determine the rates of graft rupture and contralateral ACL injury in a large cohort and to investigate patient characteristics that may be associated with these.
Case-control study; Level of evidence, 3.
A consecutive cohort of 750 patients who had undergone primary ACL reconstruction surgery with a minimum 3-year follow-up were questioned about the incidence of ACL graft rupture, contralateral ACL injury, family history of ACL injury, and current activity level. Patient databases provided details for age, sex, original injury mechanism, meniscus or articular surface injury, and graft diameter.
Responses were received from 561 patients (75%) at a mean ± SD follow-up time of 4.8 ± 1.1 years. Anterior cruciate ligament graft ruptures occurred in 25 patients (4.5%), and contralateral ACL injuries occurred in 42 patients (7.5%). The highest incidence of further ACL injury occurred in patients younger than 20 years at the time of surgery. In this group, 29% sustained a subsequent ACL injury to either knee. The odds for sustaining an ACL graft rupture or contralateral injury increased 6- and 3-fold, respectively, for patients younger than 20 years. Returning to cutting/pivoting sports increased the odds of graft rupture by a factor of 3.9 and contralateral rupture by a factor of 5. A positive family history doubled the odds for both graft rupture and contralateral ACL injury.
Patients younger than 20 years who undergo ACL reconstruction are at significantly increased risk for both graft rupture and contralateral ACL injury. Whether age per se is a risk factor or age represents a proxy for other factors remains to be determined.
同种膝关节的移植物破裂或对侧膝关节前交叉韧带（ACL）损伤是 ACL 重建手术后毁灭性的结果。虽然已经确定了许多可能增加随后 ACL 损伤风险的因素，但文献远非定论。
在大样本中确定移植物破裂和对侧 ACL 损伤的发生率，并研究可能与之相关的患者特征。
病例对照研究；证据水平，3 级。
对接受过 ACL 重建手术且随访至少 3 年的 750 例连续患者队列进行了 ACL 移植物破裂、对侧 ACL 损伤、ACL 损伤家族史和当前活动水平的调查。患者数据库提供了年龄、性别、原始损伤机制、半月板或关节面损伤以及移植物直径的详细信息。
在平均随访时间为 4.8 ± 1.1 年时，收到了 561 例患者（75%）的回复。25 例患者（4.5%）发生 ACL 移植物破裂，42 例患者（7.5%）发生对侧 ACL 损伤。在手术时年龄小于 20 岁的患者中，进一步 ACL 损伤的发生率最高。在这一组中，29%的患者的双侧膝关节均发生 ACL 损伤。对于年龄小于 20 岁的患者，发生 ACL 移植物破裂或对侧损伤的几率分别增加了 6 倍和 3 倍。重返切割/枢轴运动使移植物破裂的几率增加了 3.9 倍，对侧破裂的几率增加了 5 倍。阳性家族史使移植物破裂和对侧 ACL 损伤的几率均增加了一倍。
接受 ACL 重建手术的年龄小于 20 岁的患者，发生移植物破裂和对侧 ACL 损伤的风险显著增加。年龄本身是否是一个危险因素，或者年龄是否代表其他因素的替代物，仍有待确定。
