Krutsch Werner, Zellner J, Baumann F, Pfeifer C, Nerlich M, Angele P
Department of Trauma Surgery, University Medical Centre Regensburg, Regensburg, Germany.
Sporthopaedicum, Straubing/Regensburg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):418-425. doi: 10.1007/s00167-015-3830-2. Epub 2015 Oct 16.
Anterior cruciate ligament (ACL) ruptures are often associated with primary meniscal and cartilage lesions. Late reconstruction of ACL-deficient knees may increase the risk of developing secondary meniscal and cartilage lesions; hence, the timing of ACL repair is of the utmost importance. Because meniscus outcome is also a potential predictor for osteoarthritis (OA), this study compared ACL repair within the first 6 months after injury to that of surgery conducted 7-12 months after injury with regard to the incidence of meniscal and cartilage lesions.
This prospective cross-sectional study included all complete isolated primary ACL ruptures treated in our institution within 1 year after trauma over a 12-month period. Exclusion criteria were revision ACL, complex ligament injuries, previous knee surgery, and missing injury data. Cartilage lesions were classified according to the score established by the International Cartilage Repair Society (ICRS score) and meniscal tears according to their treatment options.
Two hundred and thirty-three of 730 patients (162 men, 71 women) with ACL repair met the inclusion criteria. 86.3 % of surgical interventions were conducted within 6 months and 13.7 % after 6 months of trauma. Severe cartilage lesions grade III-IV did not significantly differ between the different time points of ACL repair (<6 months 39.9 %; >6 months 31.3 %; p = n.s.). Medial meniscus lesions received significantly higher meniscal repair in early compared to delayed ACL repair. Significantly higher rate of meniscal repair of the medial meniscus was seen in cases of early ACL repair compared to delayed (<6 months 77.2 %, >6 months 46.7; p = 0.022). The rate of medial meniscal repair in early ACL repair was significantly higher for women (89.5-0 %; p = 0.002), however, not for men (73.3-53.8 %; p = n.s.). No differences were found for lateral meniscal lesions, with regard to neither the different time points (p = n.s.) nor the sex (p = n.s.).
Because of the significantly higher rate of prognostically advantageous meniscal repair, the recommendation for an ACL reconstruction within 6 months after trauma was made to preserve the meniscus and reduce the risk of developing OA.
Prospective cross-sectional cohort study, Level II.
前交叉韧带（ACL）断裂常伴有原发性半月板和软骨损伤。ACL缺失膝关节的晚期重建可能会增加继发性半月板和软骨损伤的风险；因此，ACL修复的时机至关重要。由于半月板的转归也是骨关节炎（OA）的一个潜在预测指标，本研究比较了损伤后6个月内进行的ACL修复与损伤后7 - 12个月进行的手术在半月板和软骨损伤发生率方面的差异。
这项前瞻性横断面研究纳入了在12个月期间内我们机构治疗的所有创伤后1年内的完全孤立性原发性ACL断裂病例。排除标准为ACL翻修、复杂韧带损伤、既往膝关节手术以及损伤数据缺失。软骨损伤根据国际软骨修复协会制定的评分标准（ICRS评分）进行分类，半月板撕裂根据其治疗方案进行分类。
730例接受ACL修复的患者中有233例（162例男性，71例女性）符合纳入标准。86.3%的手术干预在创伤后6个月内进行，13.7%在6个月后进行。在ACL修复的不同时间点，III - IV级严重软骨损伤无显著差异（<6个月为39.9%；>6个月为31.3%；p =无统计学意义）。与延迟ACL修复相比，早期内侧半月板损伤接受半月板修复的比例显著更高。与延迟ACL修复相比，早期ACL修复病例中内侧半月板修复率显著更高（<6个月为77.2%，>6个月为46.7%；p = 0.022）。早期ACL修复中女性内侧半月板修复率显著更高（89.5% - 0%；p = 0.002），而男性则无差异（73.3% - 53.8%；p =无统计学意义）。外侧半月板损伤在不同时间点（p =无统计学意义）和性别方面（p =无统计学意义）均未发现差异。
由于预后有利的半月板修复率显著更高，建议在创伤后6个月内进行ACL重建，以保护半月板并降低发生OA的风险。
前瞻性横断面队列研究，II级。
