Department of Knee Surgery and Sports Traumatology, Sonnenhof Orthopaedic Center, Bern, Switzerland.
Swiss RDL, Institute of Social and Preventive Medicine, University of Bern, Finkenhubelweg 11, 3012, Bern, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2018 Apr;26(4):1182-1189. doi: 10.1007/s00167-017-4574-y. Epub 2017 May 18.
Failure of dynamic intraligamentary stabilization (DIS) that requires revision surgery of the anterior cruciate ligament (ACL) has not been studied. The aim of this study was to investigate the incidence of revision ACL surgery, and the patient characteristics and surgery-related factors that are associated with an increased risk of ACL revision after DIS.
This study analysed a prospective, consecutively documented single-centre case series using standardized case report forms over a 2.5-year follow-up period. The primary endpoint was revision ACL surgery. We used Kaplan-Meier analysis to examine the revision-free survival time, and a multiple logistic regression model of potential risk factors including age, sex, BMI, smoking status, previous contralateral ACL injury, Tegner activity score, interval to surgery, rupture pattern, hardware removal, and postoperative side-to-side difference in knee laxity. Relative risk was calculated for subgroups of significant risk factors.
In total, 381 patients (195 male) with a mean age of 33 ± 12 years were included in the analysis. The incidence of revision ACL surgery was 30/381 (7.9%). Younger age (p = 0.001), higher Tegner activity score (p = 0.003), and increased knee laxity (p = 0.015) were significantly associated with revision ACL surgery. The increased relative risk for patients who were less than 24 years old, participated in activities at a Tegner level >5 points, or had >2 mm of side-to-side difference in knee laxity was 1.6, 3.7, and 2.3, respectively.
Young age, high level of sport activity, and high knee laxity observed in follow-up examinations increased the likelihood for revision surgery after DIS. Patients undergoing DIS should be informed of their potentially increased risk for therapy failure and carefully monitored during recovery.
Case series, Level IV.
动态关节内稳定（DIS）失效需要进行前交叉韧带（ACL）修复手术，但目前尚未对此进行研究。本研究旨在调查 ACL 修复手术后的复发率，并探讨与 DIS 后 ACL 修复风险增加相关的患者特征和手术相关因素。
本研究通过前瞻性、连续记录的单中心病例系列研究，在 2.5 年的随访期间使用标准化病例报告表进行分析。主要终点是 ACL 修复手术。我们使用 Kaplan-Meier 分析来检查无复发性生存时间，并使用多元逻辑回归模型分析包括年龄、性别、BMI、吸烟状况、对侧 ACL 损伤史、Tegner 活动评分、手术间隔时间、撕裂模式、内固定去除以及术后膝关节松弛的侧-侧差值等潜在危险因素。对于具有显著危险因素的亚组，计算相对风险。
共纳入 381 例患者（195 例男性），平均年龄为 33 ± 12 岁。ACL 修复手术的发生率为 30/381（7.9%）。年龄较小（p=0.001）、Tegner 活动评分较高（p=0.003）和膝关节松弛度增加（p=0.015）与 ACL 修复手术显著相关。年龄小于 24 岁、Tegner 活动评分大于 5 分或膝关节松弛度侧-侧差值大于 2mm 的患者，其发生 ACL 修复手术的相对风险分别为 1.6、3.7 和 2.3。
随访检查中发现的年轻、高运动水平和高膝关节松弛度增加了 DIS 后手术修复的可能性。接受 DIS 治疗的患者应被告知其潜在的治疗失败风险增加，并在康复期间进行仔细监测。
病例系列研究，IV 级。
