Magnussen Robert A, Trojani Christophe, Granan Lars-Petter, Neyret Philippe, Colombet Philippe, Engebretsen Lars, Wright Rick W, Kaeding Christopher C
Department of Orthopaedics, Sports Health and Performance Institute, The Ohio State University, Columbus, OH, 43221, USA.
Department of Orthopaedic Surgery and Sports Traumatology, Hôpital de L'Archet, University of Nice-Sophia Antipolis, Nice, France.
Knee Surg Sports Traumatol Arthrosc. 2015 Aug;23(8):2339-2348. doi: 10.1007/s00167-014-3060-z. Epub 2014 May 22.
The goal of this paper is to compare patient factors, intra-operative findings, and surgical techniques between patients followed in large cohorts in France, Norway, and North America.
Data collected on 2,286 patients undergoing revision anterior cruciate ligament reconstruction (ACLR) were obtained. These data included 1,216 patients enrolled in the Multicenter ACL Revision Study (MARS) in North America, 793 patients undergoing revision ACLR and recorded in the Norwegian Knee Ligament Registry (NKLR), and 277 patients recorded in the revision ACL database of the Société Française d'Arthroscopie (SFA) in France. Data collected from each database included patient demographics (age, sex, height, and weight), graft choice and reason for failure of the primary ACLR, time from primary to revision ACLR, pre-revision patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score, subjective International Knee Documentation Committee), associated intra-articular findings and treatments at revision, and graft choice for revision reconstruction.
Patient demographics in the three databases were relatively similar. Graft choice for primary and revision ACLR varied significantly, with more allografts used in the MARS cohort. Hamstring autograft was favoured in the NKRL, while bone-patellar tendon-bone autograft was most common in the SFA cohort. Reasons for failure of the primary ACLR were comparable, with recurrent trauma noted in 46-56 % of patients in each of the three cohorts. Technical error was cited in 44-51 % of patients in the MARS and SFA cohorts, but was not clearly elucidated in the NKLR cohort. Biologic failure of the primary graft was more common in the MARS cohort. Differences in associated intra-articular findings were noted at the time of revision ACLR, with significantly more high-grade cartilage lesions noted in the MARS group.
Significant differences exist between patient populations followed in revision ACL cohorts throughout the world that should be considered when applying findings from such cohorts to different patient populations.
Retrospective comparative study, Level III.
本文的目的是比较法国、挪威和北美的大型队列研究中患者的因素、术中发现及手术技术。
获取了2286例接受前交叉韧带翻修重建（ACLR）患者的数据。这些数据包括北美多中心ACL翻修研究（MARS）中的1216例患者、挪威膝关节韧带登记处（NKLR）记录的793例接受ACLR翻修的患者以及法国关节镜学会（SFA）的ACLR翻修数据库中记录的277例患者。从每个数据库收集的数据包括患者人口统计学信息（年龄、性别、身高和体重）、移植物选择及初次ACLR失败的原因、初次至翻修ACLR的时间、翻修前患者报告的结局评分（膝关节损伤和骨关节炎结局评分、主观国际膝关节文献委员会评分）、翻修时相关的关节内发现及治疗，以及翻修重建的移植物选择。
三个数据库中的患者人口统计学信息相对相似。初次和翻修ACLR的移植物选择有显著差异，MARS队列中使用的同种异体移植物更多。NKRL中倾向使用腘绳肌自体移植物，而在SFA队列中髌腱-骨自体移植物最为常见。初次ACLR失败的原因相似，三个队列中各有46%-56%的患者存在反复创伤。MARS和SFA队列中有44%-51%的患者被认为存在技术失误，但在NKLR队列中未明确说明。初次移植物的生物学失败在MARS队列中更为常见。翻修ACLR时发现相关关节内表现存在差异，MARS组中高级别软骨损伤明显更多。
全球ACLR翻修队列中的患者群体存在显著差异，将这些队列的研究结果应用于不同患者群体时应予以考虑。
回顾性比较研究，III级。
