Hetsroni Iftach, van-Stee Mischa, Marom Niv, Koch Jonathan E J, Dolev Eran, Maoz Guy, Nyska Meir, Mann Gideon
Department of Orthopedic Surgery, Meir General Hospital, Kfar Saba, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Orthop J Sports Med. 2017 Apr 13;5(4):2325967117700841. doi: 10.1177/2325967117700841. eCollection 2017 Apr.
There are limited data regarding associated factors of return to sports activities at more than 5 years after anterior cruciate ligament (ACL) reconstruction.
To test interrelationships between patient characteristics, concomitant articular lesions, graft laxity, and maintenance of sports activities at 5 to 10 years after ACL reconstruction. It was hypothesized that at 5 to 10 years after the operation in young adult men, maintenance of greater activity level and better knee function would be associated with greater preinjury activity level, younger age at reconstruction, absence of concomitant articular lesions, and minimal graft laxity at follow-up.
Case series; Level of evidence, 4.
One hundred six men with autologous hamstring ACL reconstruction between the ages of 18 and 35 years were reviewed at 5 to 10 years after surgery. Excluded patients had contralateral ACL tear, revision reconstruction, or another injury impairing function. Fifty-five patients were eligible and available for follow-up. Independent variables included preinjury Tegner score, time interval from injury to surgery, smoking status, age, articular lesions, KT side-to-side difference, and pivot-shift grade. Main outcome measures were Tegner activity level, International Knee Documentation Committee (IKDC) subjective score, and Knee injury and Osteoarthritis Outcome Scale (KOOS) score at 5 to 10 years after surgery.
Greater Tegner activity level at follow-up was associated in a regression model with greater preinjury Tegner activity level (correlation coefficient, 0.423; = .01), lower KT difference (correlation coefficient, -0.278; = .04), and negative pivot shift (correlation coefficient, -0.277; = .05). Younger age at operation predicted return to greater Tegner activity level in a univariate analysis (correlation coefficient, -0.266; = .05) but not in a regression model (not significant). Chondral lesions at surgery predicted lower IKDC subjective scores (71.4 ± 14.3 vs 84.1 ± 11.5; < .01) and KOOS scores but did not affect maintenance of sports activities.
At 5 to 10 years after autologous hamstring ACL reconstruction in young men, predictors of greater sports activity level are primarily high preinjury activity level and reestablishment of knee laxity. Younger age at operation and moderate chondral lesions have lower impact in this respect.
关于前交叉韧带（ACL）重建术后5年以上恢复体育活动的相关因素的数据有限。
测试ACL重建术后5至10年患者特征、合并关节损伤、移植物松弛与体育活动维持之间的相互关系。研究假设是，在年轻成年男性术后5至10年，更高的活动水平和更好的膝关节功能维持与伤前更高的活动水平、重建时更年轻的年龄、无合并关节损伤以及随访时最小的移植物松弛相关。
病例系列；证据等级，4级。
对106例年龄在18至35岁之间接受自体腘绳肌ACL重建的男性患者在术后5至10年进行了回顾。排除的患者有对侧ACL撕裂、翻修重建或其他影响功能的损伤。55例患者符合条件并可供随访。自变量包括伤前Tegner评分、受伤至手术的时间间隔、吸烟状况、年龄、关节损伤、KT双侧差值和轴移分级。主要观察指标为术后5至10年的Tegner活动水平、国际膝关节文献委员会（IKDC）主观评分以及膝关节损伤和骨关节炎疗效评分（KOOS）。
在回归模型中，随访时更高的Tegner活动水平与更高的伤前Tegner活动水平相关（相关系数，0.423；P = 0.01）、更低的KT差值（相关系数， - 0.278；P = 0.04）以及阴性轴移（相关系数， - 0.277；P = 0.05）。在单因素分析中，手术时更年轻的年龄预测了更高的Tegner活动水平恢复（相关系数， - 0.266；P = 0.05），但在回归模型中并非如此（无显著性）。手术时的软骨损伤预测了更低的IKDC主观评分（71.4 ± 14.3 vs 84.1 ± 11.5；P < 0.01）和KOOS评分，但不影响体育活动的维持。
在年轻男性自体腘绳肌ACL重建术后5至10年，更高体育活动水平的预测因素主要是高伤前活动水平和膝关节松弛的重建。手术时更年轻的年龄和中度软骨损伤在这方面的影响较小。
