Achtnich Andrea, Herbst Elmar, Forkel Philipp, Metzlaff Sebastian, Sprenker Frederike, Imhoff Andreas B, Petersen Wolf
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Arthroscopy. 2016 Dec;32(12):2562-2569. doi: 10.1016/j.arthro.2016.04.031. Epub 2016 Jun 17.
To compare clinical and radiologic results of primary anterior cruciate ligament (ACL) suture anchor repair and microfracturing with anatomic ACL single-bundle reconstruction in patients with acute proximal ACL avulsion tears.
Between January 2010 and December 2013, 420 patients underwent ACL treatment. Forty-one patients were included in this study. The inclusion criteria were as follows: unilateral acute proximal ACL rupture, concomitant meniscus lesions, no previous knee ligament surgery, and no additional ligament injuries or absence of ligament injury of the contralateral knee. Preoperative magnetic resonance imaging confirming a proximal avulsion tear of the ACL was required. Patients had to undergo surgical treatment within 6 weeks after injury. Follow-up examination included Lachman and pivot-shift testing, KT-1000 measurement, and the International Knee Documentation Committee score.
At a mean follow-up of 28 months (range, 24 to 31 month), 20 patients in each group were available. A mean KT-1000 arthrometer result of less than 3 mm indicated stability in all patients (P = .269). Three patients had a 1+ Lachman test (P = .072) and 4 patients had a 1+ pivot-shift test in the ACL repair group (P = .342). The International Knee Documentation Committee score results did not differ significantly (P > .99), but there was a significant correlation between poor results and failure rate (P = .001) in the refixation group. The failure rate was 15% in the ACL refixation group and 0% in the reconstruction group (P = .231). Magnetic resonance imaging confirmed homogeneous signal and proper ACL position in 100% of patients in the control group and 86% in the ACL repair group.
Proximal refixation of the ACL using knotless suture anchors and microfracturing restores knee stability and results in comparable functional outcomes to a control group treated with single-bundle ACL reconstruction. The results suggest that refixation of the ACL is a feasible treatment option in selected patients.
Level III, case-control study.
比较急性近端前交叉韧带（ACL）撕脱伤患者采用原发性ACL缝线锚钉修复和微骨折术与解剖型ACL单束重建术的临床和影像学结果。
2010年1月至2013年12月期间，420例患者接受了ACL治疗。本研究纳入41例患者。纳入标准如下：单侧急性近端ACL断裂、合并半月板损伤、既往无膝关节韧带手术史、对侧膝关节无额外韧带损伤或无韧带损伤。术前需磁共振成像证实ACL近端撕脱伤。患者必须在受伤后6周内接受手术治疗。随访检查包括Lachman试验和轴移试验、KT-1000测量以及国际膝关节文献委员会评分。
平均随访28个月（范围24至31个月），每组各有20例患者可供分析。所有患者的平均KT-1000关节测量仪结果小于3 mm表示膝关节稳定（P = 0.269）。ACL修复组有3例患者Lachman试验为1+（P = 0.072），4例患者轴移试验为1+（P = 0.342）。国际膝关节文献委员会评分结果差异无统计学意义（P > 0.99），但在重新固定组中，结果不佳与失败率之间存在显著相关性（P = 0.001）。ACL重新固定组的失败率为15%，重建组为0%（P = 0.231）。磁共振成像证实对照组100%的患者和ACL修复组86%的患者信号均匀且ACL位置正常。
使用无结缝线锚钉对ACL进行近端重新固定和微骨折术可恢复膝关节稳定性，其功能结果与单束ACL重建治疗的对照组相当。结果表明，在选定的患者中，ACL重新固定是一种可行的治疗选择。
III级，病例对照研究。
