Schilaty Nathan D, Bates Nathaniel A, Sanders Thomas L, Krych Aaron J, Stuart Michael J, Hewett Timothy E
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA.
Am J Sports Med. 2017 Jun;45(7):1567-1573. doi: 10.1177/0363546517694026. Epub 2017 Mar 1.
Second anterior cruciate ligament (ACL) tears after reconstruction occur at a reported rate of 20% to 30%. This high frequency indicates that there may be factors that predispose an athlete to graft failure and ACL tears of the contralateral knee.
To determine the incidence of second ACL injuries in a geographic population-based cohort over a 10-year observation period.
Descriptive epidemiological study.
International Classification of Diseases, 9th Revision (ICD-9) codes relevant to the diagnosis of an ACL tear and the procedure code for ACL reconstruction were searched across the Rochester Epidemiology Project, a multidisciplinary county database, between the years of 1990 and 2000. This cohort of patients was tracked for subsequent ACL injuries through December 31, 2015. The authors identified 1041 patients with acute, isolated ACL tears. These patients were stratified by primary and secondary tears, sex, age, activity level, side of injury, sex by side of injury, and graft type.
Of the 1041 unique patients with a diagnosed ACL tear in Olmsted County, Minnesota, from 1990 to 2000, there were 66 (6.0%) second ACL tears; 66.7% of these tears occurred on the contralateral side. A second ACL injury was influenced by graft type ( P < .0001), election of ACL reconstruction ( P = .0060), and sex by side of injury ( P = .0072). Nonparametric analysis of graft disruption by graft type demonstrated a higher prevalence of second ACL tears with allografts compared with hamstring ( P = .0499) or patellar tendon autografts ( P = .0012).
The incidence of second ACL tears in this population-based cohort was 6.0%, with 66.7% of these tears occurring on the contralateral side from the original injury. There was a high population incidence of second ACL injuries in female patients younger than age 20 years. The utilization of patellar tendon autografts significantly reduced the risk of second ACL injuries compared with allografts or hamstring autografts in this cohort.
据报道，前交叉韧带（ACL）重建术后二次撕裂的发生率为20%至30%。如此高的发生率表明，可能存在一些因素使运动员易于出现移植物失败以及对侧膝关节的ACL撕裂。
确定在一个基于地理人群的队列中，经过10年观察期后二次ACL损伤的发生率。
描述性流行病学研究。
在罗切斯特流行病学项目（一个多学科的县级数据库）中，检索1990年至2000年间与ACL撕裂诊断相关的国际疾病分类第九版（ICD - 9）编码以及ACL重建的手术编码。对该队列患者进行追踪，直至2015年12月31日，以了解后续的ACL损伤情况。作者确定了1041例急性、孤立性ACL撕裂患者。这些患者按初次和二次撕裂、性别、年龄、活动水平、损伤侧、损伤侧别与性别的关系以及移植物类型进行分层。
在明尼苏达州奥尔姆斯特德县1990年至2000年间确诊为ACL撕裂的1041例患者中，有66例（6.0%）出现二次ACL撕裂；其中66.7%的撕裂发生在对侧。二次ACL损伤受移植物类型（P <.0001）、ACL重建的选择（P =.0060）以及损伤侧别与性别的关系（P =.0072）影响。按移植物类型对移植物断裂进行的非参数分析表明，与腘绳肌移植物（P =.0499）或髌腱自体移植物相比，同种异体移植物出现二次ACL撕裂的发生率更高（P =.0012）。
在这个基于人群的队列中，二次ACL撕裂的发生率为6.0%，其中66.7%的撕裂发生在与初次损伤对侧的膝关节。20岁以下女性患者中二次ACL损伤的人群发生率较高。在该队列中，与同种异体移植物或腘绳肌自体移植物相比，使用髌腱自体移植物可显著降低二次ACL损伤的风险。
