Thaunat Mathieu, Clowez Gilles, Saithna Adnan, Cavalier Maxime, Choudja Eric, Vieira Thais D, Fayard Jean-Marie, Sonnery-Cottet Bertrand
Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France.
Southport & Ormskirk Hospitals, Southport, UK.
Am J Sports Med. 2017 Sep;45(11):2569-2577. doi: 10.1177/0363546517708982. Epub 2017 Jun 13.
Early clinical results of anterolateral ligament (ALL) reconstruction are promising, but concerns exist due to high rates of complications after other types of lateral extra-articular tenodesis. The rate of surgery after combined anterior cruciate ligament (ACL) and ALL reconstruction is not known.
To determine the rate of reoperation after combined ACL and ALL reconstruction.
Case series; Level of evidence, 4.
A retrospective analysis of prospectively collected data from the Scientific ACL Network International (SANTI) Study Group database was performed to include all patients who had undergone combined ACL and ALL reconstruction between January 2012 and June 2014. At the end of the study period, all patients were contacted by telephone, and the operative notes of those who stated that they had undergone reoperation were reviewed to determine the type and rates of the subsequent procedures performed. Descriptive data were analyzed for the entire patient cohort.
The study population comprised 548 quadruple hamstring graft (4HT)+ALL reconstructions. The mean age (±SD) was 24.3 ± 7.9 years (range, 11.9-55.7 years), and 70.3% of subjects were male. The mean duration of follow-up was 35.5 ± 8.0 months (range, 24-54 months). Seventy-two patients (13.1%) underwent ipsilateral reoperation. This comprised a total of 77 procedures. Graft revision occurred in 14 knees (2.6%) at a mean of 18.3 months (±7.4 months) after the index procedure. There were 63 reoperations for ipsilateral, non-graft rupture-related indications (meniscus, n = 30; arthrofibrosis, n = 22; removal of hardware, n = 4; deep infection, n = 3; arthroscopic lavage without infection, n = 4). The only specific complications related to the ALL procedure (n = 3) were all related to femoral hardware that required removal. In both univariate and multivariate analyses, only the presence of a medial meniscal lesion at the index procedure was significantly associated with ipsilateral reoperation (odds ratio, 2.58; 95% CI, 1.43-4.76; P = .002).
The reoperation rate after combined ACL and ALL reconstruction in this series is broadly comparable to the reoperation rate after isolated ACL reconstruction as reported in previous studies. In addition, the high rates of knee stiffness and reoperation reported in historical series of nonanatomic, lateral extra-articular tenodesis were not observed in the current series.
前外侧韧带（ALL）重建的早期临床结果很有前景，但由于其他类型的外侧关节外腱固定术后并发症发生率较高，仍存在一些担忧。前交叉韧带（ACL）和ALL联合重建后的手术率尚不清楚。
确定ACL和ALL联合重建后的再次手术率。
病例系列；证据等级，4级。
对前瞻性收集的来自国际科学ACL网络（SANTI）研究组数据库的数据进行回顾性分析，纳入2012年1月至2014年6月期间接受ACL和ALL联合重建的所有患者。在研究期结束时，通过电话联系所有患者，并查阅那些表示接受过再次手术的患者的手术记录，以确定后续手术的类型和发生率。对整个患者队列进行描述性数据分析。
研究人群包括548例四股腘绳肌腱移植（4HT）+ALL重建。平均年龄（±标准差）为24.3±7.9岁（范围11.9 - 55.7岁），70.3%的受试者为男性。平均随访时间为35.5±8.0个月（范围24 - 54个月）。72例患者（13.1%）接受了同侧再次手术。这包括总共77次手术。在初次手术平均18.3个月（±7.4个月）后，14例膝关节（2.6%）进行了移植物翻修。有63例因同侧非移植物破裂相关指征进行再次手术（半月板，n = 30；关节纤维化，n = 22；取出内固定物，n = 4；深部感染，n = 3；无感染的关节镜灌洗，n = 4）。与ALL手术相关的唯一特定并发症（n = 3）均与需要取出的股骨内固定物有关。在单因素和多因素分析中，仅初次手术时存在内侧半月板损伤与同侧再次手术显著相关（比值比，2.58；95%置信区间，1.43 - 4.76；P = .002）。
本系列中ACL和ALL联合重建后的再次手术率与先前研究报道的单纯ACL重建后的再次手术率大致相当。此外，在当前系列中未观察到历史系列中非解剖学外侧关节外腱固定术报道的高膝关节僵硬和再次手术率。
