Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany.
Knee Surg Sports Traumatol Arthrosc. 2017 Dec;25(12):3923-3928. doi: 10.1007/s00167-017-4445-6. Epub 2017 Feb 17.
Primary repair of the anterior cruciate ligament (ACL) has regained interest of clinicians with recent development of novel repair techniques. Dynamic intraligamentary stabilisation was introduced in an attempt to promote healing by shielding cyclic loads acting upon the ACL during the healing phase. The aim of this study was to identify negative factors likely to influence success of this procedure.
Between 2009 and 2014, 264 patients with an acute ACL rupture undergoing dynamic intraligamentary stabilisation were included in this study. Patients were evaluated for anterior/posterior laxity; range of motion and patient reported outcome measures. Adverse events and re-operations were noted. Failure was defined as AP Translation >3 mm, re-rupture or conversion to ACL reconstruction. Minimum follow-up was 24 months. Univariate and multivariate regression models were utilized to determine predictors of failure.
An overall complication rate of 15.1% was noted comprising 9.5% (n = 25) re-ruptures, 4.1% (n = 11) persistent instability, and 1.5% (n = 4) > 10° fixed flexion deformity. Two factors were identified as negative predictors of failure: (1) pursuit of competitive sport activities with a Tegner pre-injury score >7 (Odds Ratio (OR) 4.4, CI 1.2-15.9, p = 0.02) and (2) mid-substance ACL rupture location (OR 2.5, 1.1-5.7, p = 0.02). When neither of those risk factors occurred the failure rate was limited to 3.9%.
Correct patient selection and narrowing of indications are necessary to maintain high success rates of the procedure. Mid-substance ACL ruptures and a high pre-injury sports activity level are two predictors of inferior outcome.
II.
随着新型修复技术的发展，前交叉韧带（ACL）的初次修复重新引起了临床医生的兴趣。动态内韧带稳定技术的引入是为了通过在愈合阶段屏蔽作用于 ACL 的循环负荷来促进愈合。本研究的目的是确定可能影响该手术成功的负面因素。
2009 年至 2014 年期间，共纳入 264 例急性 ACL 断裂行动态内韧带稳定术的患者。对患者进行前/后松弛度、活动范围和患者报告的结果测量评估。记录不良事件和再次手术。失败的定义为 AP 平移>3mm、再断裂或转换为 ACL 重建。最低随访时间为 24 个月。采用单变量和多变量回归模型来确定失败的预测因素。
总的并发症发生率为 15.1%，包括 9.5%（n=25）的再断裂、4.1%（n=11）的持续性不稳定和 1.5%（n=4）>10°的固定屈曲畸形。有两个因素被确定为失败的负预测因素：（1）从事竞技体育活动，受伤前的 Tegner 评分>7（优势比（OR）4.4，CI 1.2-15.9，p=0.02）；（2）ACL 中部位断裂（OR 2.5，1.1-5.7，p=0.02）。当这两个危险因素都不存在时，失败率限制在 3.9%。
正确的患者选择和缩小适应证是保持该手术高成功率的必要条件。ACL 中部位断裂和高伤前运动水平是预后不良的两个预测因素。
II。
