Shelbourne K Donald, Benner Rodney W, Gray Tinker
Shelbourne Knee Center, Indianapolis, Indiana, USA
Shelbourne Knee Center, Indianapolis, Indiana, USA.
Am J Sports Med. 2014 Jun;42(6):1395-400. doi: 10.1177/0363546514524921. Epub 2014 Mar 13.
The return-to-sport and reinjury rates are not well defined after revision anterior cruciate ligament (ACL) reconstruction.
School-age athletes would have a higher rate of return to sports and reinjury to either knee after revision ACL surgery compared with college or recreational athletes.
Cohort study; Level of evidence, 2.
Patients were prospectively studied after revision ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft. Participants were grouped by competitive sport levels of school age (mean age, 16.6 ± 0.9 years; n = 84), college (19.6 ± 1.2 years; n = 58), or recreational adult (27.6 ± 4.1 years; n = 117). An activity survey was used to determine the specific sport and sport level patients participated in before and after surgery. The International Knee Documentation Committee (IKDC) knee survey and Cincinnati Knee Rating System (CKRS) survey responses were also obtained.
The rate of return to the same sport at the same level was 62 of 84 school-age athletes (74%), 43 of 58 college athletes (74%), and 73 of 117 recreational athletes (62%) (P = .1065). The number of patients who had a subsequent ACL graft tear rate after revision surgery was 2 of 84 (2.3%) in the high school group, 3 of 58 (5.1%) in the college group, and 4 of 117 (3.4%) in the recreational group (P = .6706). The number of patients who had a subsequent ACL tear in the contralateral knee was 1 of 84 (1.1%) in the school-age group, 1 of 58 (1.7%) in the college group, and 2 of 117 (1.7%) in the recreational group (P = .9501). At 2 years postoperatively, the mean IKDC subjective total score was 86.1 ± 11.7 points and the mean CKRS total score was 89.7 ± 11.1 points.
Revision ACL reconstruction with BPTB autograft and perioperative rehabilitation allowed high school and college athletes to return to sports at the preinjury level at a rate of 74%; the return rate for recreational-level adults was 62%. Reinjury rates in the first 5 years after revision surgery ranged from 2% to 5%, which is lower than what has been reported for young competitive athletes after primary surgery.
前交叉韧带（ACL）重建翻修术后恢复运动及再次受伤的发生率尚不明确。
与大学运动员或业余运动员相比，学龄期运动员在ACL重建翻修术后恢复运动及再次受伤的发生率更高。
队列研究；证据等级为2级。
对采用自体骨-髌腱-骨（BPTB）移植进行ACL重建翻修术的患者进行前瞻性研究。参与者按竞技运动水平分组，包括学龄期（平均年龄16.6±0.9岁；n = 84）、大学（19.6±1.2岁；n = 58）或业余成年组（27.6±4.1岁；n = 117）。通过活动调查确定患者手术前后参与的具体运动及运动水平。还获取了国际膝关节文献委员会（IKDC）膝关节调查问卷和辛辛那提膝关节评分系统（CKRS）调查问卷的回复。
84名学龄期运动员中有62名（74%）、58名大学运动员中有43名（74%）、117名业余运动员中有73名（62%）以相同水平恢复到同一项运动（P = 0.1065）。翻修术后出现后续ACL移植物撕裂的患者数量，高中组84名中有2名（2.3%），大学组58名中有3名（5.1%），业余组117名中有4名（3.4%）（P = 0.6706）。对侧膝关节出现后续ACL撕裂的患者数量，学龄期组84名中有1名（1.1%），大学组58名中有1名（1.7%），业余组117名中有2名（1.7%）（P = 0.9501）。术后2年，IKDC主观总分平均为86.1±11.7分，CKRS总分平均为89.7±11.1分。
采用BPTB自体移植及围手术期康复的ACL重建翻修术使高中和大学运动员以74%的比例恢复到伤前运动水平；业余水平成年人的恢复率为62%。翻修术后前5年的再次受伤率在2%至5%之间，低于初次手术后年轻竞技运动员的报告发生率。
