Leroux Timothy, Wasserstein David, Dwyer Tim, Ogilvie-Harris Darrell J, Marks Paul H, Bach Bernard R, Townley John B, Mahomed Nizar, Chahal Jaskarndip
University of Toronto Orthopaedic Sports Medicine Program (Women's College Hospital), Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
University of Toronto Orthopaedic Sports Medicine Program (Women's College Hospital), Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Am J Sports Med. 2014 Nov;42(11):2666-72. doi: 10.1177/0363546514548165. Epub 2014 Sep 11.
Knowledge of the rate of and risk factors for re-revision, reoperation, and readmission after revision anterior cruciate ligament reconstruction (ACLR) is limited.
To determine the rate of and risk factors for re-revision, reoperation, and readmission after revision ACLR.
Descriptive epidemiology study.
All patients who underwent first revision ACLR in Ontario, Canada, from January 2004 to December 2010 were identified and followed until December 2012. Exclusions included age <16 years, previous osteotomy, or multiligament knee reconstruction. The main outcome was re-revision ACLR. Secondary outcomes included reoperation (irrigation and debridement [I&D], meniscectomy, manipulation under anesthesia, contralateral ACLR, and total knee arthroplasty) and readmission. Survival to re-revision was determined using the Kaplan-Meier approach. A Cox proportional hazards model or logistic regression were used to determine the influence of patient, surgical, and provider factors on outcomes. A post hoc analysis was performed to determine the influence of the aforementioned factors on postoperative infection risk.
Overall, 827 patients were included (median age, 30 years; 58.8% males). Single-stage revisions comprised 92.9% of cases, and a meniscal procedure (repair or debridement) was performed in 45.3% of cases. The re-revision rate at a mean follow-up of 4.8 ± 2.2 years was 4.4%, and the 5-year survival rate was 95.4%. The rates of I&D, meniscectomy, contralateral ACLR, and readmission were 0.8%, 3.1%, 3.4%, and 4.1%, respectively. Manipulation under anesthesia and total knee arthroplasty were rare. Young age significantly increased contralateral ACLR risk (risk decreased by 5.1% with each year of age >16 years; P = .02) but not re-revision ACLR risk. Low surgeon's annual volume of revision ACLR (<4 revisions/year: odds ratio, 1.2; P = .02) and male sex (odds ratio, 13.3; P = .01) significantly increased overall infection risk; male sex also influenced I&D risk.
Re-revision, reoperation, and readmission rates after revision ACLR were low, and the risk for I&D, infection, and contralateral ACLR were influenced by male sex, low surgeon volume, and young age, respectively.
This is the first study to determine morbidity rates and risk factors after revision ACLR, providing reference data from the general population.
关于前交叉韧带重建翻修术后再次翻修、再次手术和再次入院的发生率及危险因素的了解有限。
确定前交叉韧带重建翻修术后再次翻修、再次手术和再次入院的发生率及危险因素。
描述性流行病学研究。
确定2004年1月至2010年12月在加拿大安大略省接受首次前交叉韧带重建翻修术的所有患者，并随访至2012年12月。排除标准包括年龄<16岁、既往截骨术或多韧带膝关节重建术。主要结局是前交叉韧带重建再次翻修术。次要结局包括再次手术（冲洗和清创、半月板切除术、麻醉下手法操作、对侧前交叉韧带重建和全膝关节置换术）和再次入院。采用Kaplan-Meier方法确定再次翻修的生存率。使用Cox比例风险模型或逻辑回归来确定患者、手术和医疗服务提供者因素对结局的影响。进行事后分析以确定上述因素对术后感染风险的影响。
总体而言，纳入827例患者（中位年龄30岁；58.8%为男性）。单阶段翻修占病例的92.9%，45.3%的病例进行了半月板手术（修复或清创）。平均随访4.8±2.2年时，再次翻修率为4.4%，5年生存率为95.4%。冲洗和清创、半月板切除术、对侧前交叉韧带重建和再次入院的发生率分别为0.8%、3.1%、3.4%和4.1%。麻醉下手法操作和全膝关节置换术很少见。年轻显著增加对侧前交叉韧带重建风险（年龄每增加1岁>16岁，风险降低5.1%；P = 0.02），但不增加前交叉韧带重建再次翻修风险。外科医生每年前交叉韧带重建翻修手术量低（<4次翻修/年：比值比，1.2；P = 0.02）和男性性别（比值比，13.3；P = 0.01）显著增加总体感染风险；男性性别也影响冲洗和清创风险。
前交叉韧带重建翻修术后再次翻修、再次手术和再次入院率较低，冲洗和清创、感染及对侧前交叉韧带重建风险分别受男性性别、外科医生手术量低和年轻的影响。
这是第一项确定前交叉韧带重建翻修术后发病率及危险因素的研究，提供了来自普通人群的参考数据。
