Riff Andrew J, Luchetti Timothy J, Weber Alexander E, Chahal Jaskarndip, Bach Bernard R
Rush University Medical Center, Chicago, Illinois, USA.
University of Southern California, Los Angeles, California, USA.
Orthop J Sports Med. 2017 Aug 29;5(8):2325967117724345. doi: 10.1177/2325967117724345. eCollection 2017 Aug.
During the preoperative discussion prior to anterior cruciate ligament reconstruction (ACLR), patients are often interested in data regarding rates of revision reconstruction, reoperation, concomitant pathologic changes, and future contralateral ACL injury.
To analyze a single surgeon's experience with primary and revision ACLR over a 30-year interval, focusing on incidence and risk factors for revision and reoperation.
Case series; Level of evidence, 4.
Patients who underwent ACLR from 1986 to 2016 were identified from a prospectively maintained database. Covariates of interest included age, sex, time, and graft selection. Outcomes of interest included revision and reoperation rates.
A total of 2450 ACLRs (mean patient age, 29 years; 58% male) were reviewed. Among primary ACLRs performed (n = 2225), 68% entailed bone-patellar tendon-bone (BTB) autograft and 30% entailed BTB allograft. Patients undergoing ACLR with autograft and allograft had a mean age of 22 and 37 years, respectively. The rate of revision ACLR was 1.8% and 3.5% for primary and revision cases, respectively. An increased rate of revision was noted among females compared with males (2.6% vs 1.2%) and among allografts compared with autografts (2.7% vs 1.3%). Low-dose irradiation did not affect allograft revision rates. The nonrevision reoperation rate following primary ACLR was 12%. The nonrevision reoperation rate was lower among primary cases reconstructed with allograft than autograft (9% vs 13%). Seventeen percent of cases involved concomitant meniscal repair and, among these, 13% required revision meniscal surgery. The rate of contralateral ACLR was 5.3.
This information is useful in the informed consent process, for perioperative decision making regarding graft choice, and for identifying patients who are at risk for injuring the uninvolved knee.
在进行前交叉韧带重建术（ACLR）前的术前讨论中，患者通常对翻修重建率、再次手术率、合并病理改变以及未来对侧前交叉韧带损伤的数据感兴趣。
分析一名外科医生在30年间进行初次和翻修ACLR的经验，重点关注翻修和再次手术的发生率及危险因素。
病例系列；证据等级，4级。
从一个前瞻性维护的数据库中识别出1986年至2016年期间接受ACLR的患者。感兴趣的协变量包括年龄、性别、时间和移植物选择。感兴趣的结果包括翻修率和再次手术率。
共回顾了2450例ACLR手术（患者平均年龄29岁；58%为男性）。在初次ACLR手术（n = 2225）中，68%采用骨-髌腱-骨（BTB）自体移植物，30%采用BTB同种异体移植物。接受自体移植物和同种异体移植物ACLR的患者平均年龄分别为22岁和37岁。初次和翻修病例的ACLR翻修率分别为1.8%和3.5%。女性的翻修率高于男性（2.6%对1.2%），同种异体移植物的翻修率高于自体移植物（2.7%对1.3%）。低剂量辐射不影响同种异体移植物的翻修率。初次ACLR后的非翻修再次手术率为12%。同种异体移植物重建的初次病例的非翻修再次手术率低于自体移植物（9%对13%）。17%的病例涉及半月板修复，其中13%需要翻修半月板手术。对侧ACLR率为5.3。
这些信息在知情同意过程、关于移植物选择的围手术期决策以及识别未受累膝关节受伤风险患者方面很有用。
