Sanders Thomas L, Maradit Kremers Hilal, Bryan Andrew J, Kremers Walter K, Levy Bruce A, Dahm Diane L, Stuart Michael J, Krych Aaron J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Am J Sports Med. 2016 Jun;44(6):1558-64. doi: 10.1177/0363546516630751. Epub 2016 Feb 29.
Among patients treated nonoperatively for 1 year after anterior cruciate ligament (ACL) disruption, little is known about the frequency of ACL reconstruction within the first year of injury and the effect of age range, sex, and meniscal tears on the incidence of ACL reconstruction between 1 and 10 years after injury.
To (1) define the rate of delayed ACL reconstruction (between 1 and 10 years after injury) in a population-based cohort of isolated ACL tears and (2) evaluate predictive factors associated with delayed reconstruction.
Case-control study; Level of evidence, 3.
The study included a population-based cohort of 1841 patients with new-onset, isolated ACL tears that occurred between January 1, 1990, and December 31, 2010. The complete medical records were reviewed to confirm diagnosis and collect data on clinical characteristics and details of subsequent ACL surgery. To evaluate the incidence of ACL reconstruction between 1 and 10 years after injury, landmark survival analysis was performed with a landmark set at 1 year after injury. Early and late predictors of ACL reconstruction were analyzed using Cox proportional hazards regression.
A total of 661 patients were treated nonoperatively for the first year after ACL tears. Over a mean 10 years of follow-up, 213 patients (32%) underwent ACL reconstruction between 1 and 10 years after injury. Young age (hazard ratio [HR], 0.55 per decade increase in age; 95% CI, 0.48-0.62) and meniscal tear at injury (HR, 1.48; 95% CI, 1.12-1.95) were significant predictors of undergoing delayed reconstruction. The rate of delayed ACL reconstruction decreased significantly over the study period (P < .03). There was no association between sex (HR, 0.89; 95% CI, 0.67-1.16) and delayed ACL reconstruction. Among patients who had delayed ACL reconstruction, 40% experienced a secondary meniscal tear before surgery.
In this study population of 1841 patients, 62% of patients received ACL reconstruction within 1 year of injury. Of patients treated nonoperatively for 1 year after ACL tears, 32% underwent delayed ACL reconstruction. Predictors of reconstruction beyond 1 year were young age (50% reduction in reconstruction per decade increased age) and baseline meniscal tear. Sex was not predictive for reconstruction beyond 1 year from injury.
在前交叉韧带（ACL）断裂后接受非手术治疗1年的患者中，对于损伤后第1年内ACL重建的频率以及年龄范围、性别和半月板撕裂对损伤后1至10年ACL重建发生率的影响知之甚少。
（1）确定基于人群的孤立性ACL撕裂队列中延迟ACL重建（损伤后1至10年）的发生率，以及（2）评估与延迟重建相关的预测因素。
病例对照研究；证据等级，3级。
该研究纳入了1990年1月1日至2010年12月31日期间新发孤立性ACL撕裂的1841例患者的人群队列。回顾完整的医疗记录以确认诊断，并收集临床特征和后续ACL手术细节的数据。为了评估损伤后1至10年ACL重建的发生率，进行了标志性生存分析，标志性时间设定为损伤后1年。使用Cox比例风险回归分析ACL重建的早期和晚期预测因素。
共有661例患者在ACL撕裂后的第1年接受了非手术治疗。在平均10年的随访中，213例患者（32%）在损伤后1至10年接受了ACL重建。年轻（风险比[HR]，年龄每增加十岁为0.55；95%可信区间[CI]，0.48 - 0.62）和损伤时半月板撕裂（HR，1.48；95% CI，1.12 - 1.95）是接受延迟重建的显著预测因素。在研究期间，延迟ACL重建的发生率显著下降（P < 0.03）。性别与延迟ACL重建之间无关联（HR，0.89；95% CI，0.67 - （此处原文有误，应为1.16））。在延迟进行ACL重建的患者中，40%在手术前出现了继发性半月板撕裂。
在这个包含1841例患者的研究人群中，62%的患者在损伤后1年内接受了ACL重建。在ACL撕裂后接受1年非手术治疗的患者中，32%接受了延迟ACL重建。损伤后1年以上重建的预测因素是年轻（年龄每增加十岁重建率降低50%）和基线半月板撕裂。性别不是损伤后1年以上重建的预测因素。
