Fältström Anne, Hägglund Martin, Magnusson Henrik, Forssblad Magnus, Kvist Joanna
Department of Physiotherapy, Ryhov County Hospital, 551 85, Jönköping, Sweden.
Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Knee Surg Sports Traumatol Arthrosc. 2016 Mar;24(3):885-94. doi: 10.1007/s00167-014-3406-6. Epub 2014 Nov 1.
To identify predictors for additional anterior cruciate ligament (ACL) reconstruction.
Patients from the Swedish national ACL register who underwent ACL reconstruction between January 2005 and February 2013 (follow-up duration 6-104 months) were included. Cox regression analyses included the following independent variables regarding primary injury: age, sex, time between injury and primary ACL reconstruction, activity at primary injury, concomitant injuries, injury side, graft type, and pre-surgery KOOS and EQ-5D scores.
Among ACL reconstruction procedures, 93% involved hamstring tendon (HT) autografts. Graft type did not predict additional ACL reconstruction. Final regression models only included patients with HT autograft (n = 20,824). Of these, 702 had revision and 591 contralateral ACL reconstructions. The 5-year post-operative rates of revision and contralateral ACL reconstruction were 4.3 and 3.8%, respectively. Significant predictors for additional ACL reconstruction were age (fourfold increased rate for <16-year-old patients vs. >35-year-old patients), time between injury and primary surgery (two to threefold increased rate for ACL reconstruction within 0-90 days vs. >365 days), and playing football at primary injury.
This study identified younger age, having ACL reconstruction early after the primary injury, and incurring the primary injury while playing football as the main predictors for revision and contralateral ACL reconstruction. This suggests that the rate of additional ACL reconstruction is increased in a selected group of young patients aiming to return to strenuous sports after primary surgery and should be taken into consideration when discussing primary ACL reconstruction, return to sports, and during post-surgery rehabilitation.
II.
确定前交叉韧带（ACL）再次重建的预测因素。
纳入2005年1月至2013年2月间在瑞典国家ACL登记处接受ACL重建的患者（随访时间6 - 104个月）。Cox回归分析纳入了以下关于初次损伤的独立变量：年龄、性别、损伤与初次ACL重建之间的时间、初次损伤时的活动情况、合并损伤、损伤侧、移植物类型以及术前KOOS和EQ - 5D评分。
在ACL重建手术中，93%采用了腘绳肌腱（HT）自体移植物。移植物类型不能预测再次进行ACL重建。最终回归模型仅纳入了采用HT自体移植物的患者（n = 20,824）。其中，702例进行了翻修手术，591例进行了对侧ACL重建。翻修手术和对侧ACL重建的术后5年发生率分别为4.3%和3.8%。再次进行ACL重建的显著预测因素包括年龄（16岁以下患者与35岁以上患者相比发生率增加四倍）、损伤与初次手术之间的时间（0 - 90天内进行ACL重建与超过365天相比发生率增加两到三倍）以及初次损伤时踢足球。
本研究确定年龄较小、初次损伤后早期进行ACL重建以及在踢足球时发生初次损伤是翻修手术和对侧ACL重建的主要预测因素。这表明在一组旨在初次手术后恢复剧烈运动的年轻患者中，再次进行ACL重建的发生率会增加，在讨论初次ACL重建、恢复运动以及术后康复过程中应予以考虑。
II级。
