双半月板修复的前交叉韧带重建失败率高：一项病例对照研究。
High failure rate of anterior cruciate ligament reconstruction with bimeniscal repair: A case-control study.
作者信息
Gonçalves H, Steltzlen C, Boisrenoult P, Beaufils P, Pujol N
机构信息
Service d'orthopédie traumatologie, centre hospitalier de Versailles, université Versailles-Saint-Quentin, 177, rue de Versailles, 78157 Le Chesnay, France.
Service d'orthopédie traumatologie, centre hospitalier de Versailles, université Versailles-Saint-Quentin, 177, rue de Versailles, 78157 Le Chesnay, France.
出版信息
Orthop Traumatol Surg Res. 2017 Oct;103(6):943-946. doi: 10.1016/j.otsr.2017.03.022. Epub 2017 May 25.
BACKGROUND
Bimeniscal lesions are common in patients with anterior cruciate ligament (ACL) tears. However, bimeniscal repair is rarely performed during ACL reconstruction.
OBJECTIVE
To assess outcomes after ACL reconstruction with bimeniscal repair.
HYPOTHESIS
Bimeniscal lesions, even when repaired, are associated with poorer outcomes of ACL reconstruction.
MATERIAL AND METHODS
A retrospective case-control design was used. The cases were 15 patients who underwent ACL reconstruction, without procedures on any other ligaments, combined with bimeniscal repair, between May 2009 and May 2013 (3.2% of all ACL reconstructions during the study period). This group (2-Mc group) was matched on age, gender, body mass index, and time to surgery to 30 patients who underwent ACL reconstruction and had no meniscal lesions (0-Mc group) and to 30 patients who underwent ACL reconstruction and repair of the medial meniscus (1-Mc group). After a mean follow-up of 3.6 years, clinical outcomes were assessed based on the KOOS, Lysholm, and IKDC scores and knee laxity based on TELOS and GNRB measurements. The primary outcome measure was the rate of ACL re-rupture. Secondary outcome measures were functional outcomes and rate of delayed meniscectomy.
RESULTS
The ACL re-rupture rate was significantly higher in the 2-Mc group than in the 0-Mc and 1-Mc groups pooled (20%, vs. 1.7%; P=0.02). The functional scores showed no significant differences across groups. Post-operative differential laxity was significantly greater in the 2-Mc group (3.3mm by TELOS, P=0.02; and 2.5mm by GNRB, P=0.03) than in the 0-Mc and 1-Mc groups pooled. Delayed meniscectomy was performed in none of the 2-Mc group patients and in 2 of the 1-Mc group patients.
CONCLUSION
ACL reconstruction combined with bimeniscal repair is a rarely performed procedure. It is associated with a high ACL re-rupture rate and greater differential laxity. Meniscal outcomes of bimeniscal repair, in contrast, are good.
LEVEL OF EVIDENCE
III, matched case-control study.
背景
双半月板损伤在前交叉韧带（ACL）撕裂患者中很常见。然而，在ACL重建过程中很少进行双半月板修复。
目的
评估ACL重建联合双半月板修复后的疗效。
假设
双半月板损伤即使修复后，也与ACL重建的较差疗效相关。
材料与方法
采用回顾性病例对照设计。病例为2009年5月至2013年5月期间接受ACL重建且未对任何其他韧带进行手术，同时联合双半月板修复的15例患者（占研究期间所有ACL重建的3.2%）。该组（2-Mc组）在年龄、性别、体重指数和手术时间方面与30例接受ACL重建且无半月板损伤的患者（0-Mc组）以及30例接受ACL重建并修复内侧半月板的患者（1-Mc组）进行匹配。平均随访3.6年后，根据KOOS、Lysholm和IKDC评分评估临床疗效，并根据TELOS和GNRB测量评估膝关节松弛度。主要结局指标是ACL再次断裂率。次要结局指标是功能结局和延迟半月板切除术的发生率。
结果
2-Mc组的ACL再次断裂率显著高于合并的0-Mc组和1-Mc组（20%对1.7%；P=0.02）。功能评分在各组之间无显著差异。2-Mc组术后的差异松弛度显著大于合并的0-Mc组和1-Mc组（TELOS测量为3.3mm，P=0.02；GNRB测量为2.5mm，P=0.03）。2-Mc组患者均未进行延迟半月板切除术，1-Mc组有2例患者进行了延迟半月板切除术。
结论
ACL重建联合双半月板修复是一种很少进行的手术。它与较高的ACL再次断裂率和更大的差异松弛度相关。相比之下，双半月板修复的半月板结局良好。
证据水平
III级，匹配病例对照研究。
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