Hoffmann Christof, Friederichs Jan, von Rüden Christian, Schaller Christian, Bühren Volker, Moessmer Christoph
Department of Trauma Surgery, BG Trauma Center Murnau, Professor Küntscher Str. 8, 82418, Murnau, Germany.
Department of Trauma Surgery and Sports Orthopaedics, Garmisch-Partenkirchen Medical Center, Garmisch-Partenkirchen, 82467, Germany.
J Orthop Surg Res. 2017 Nov 13;12(1):171. doi: 10.1186/s13018-017-0678-9.
Current studies demonstrate encouraging short-term results after primary anterior cruciate ligament (ACL) suture anchor repair. However, earlier studies reported deterioration of knee function at 5-year follow-up following good clinical short-term recovery. Therefore, the aim of this study was to evaluate clinical long-term results after primary ACL repair at a minimum 5-year follow-up.
In a retrospective study, 13 patients were included between 2009 and 2012. Inclusion criteria were an acute proximal, femoral avulsion tear of the ACL with good tissue quality and sagittal instability in a healthy, demanding patient. Patients suffering proximal tibial fractures, arthrosis, or multiligamentous injuries of the knee were excluded. The ACL was anchored to the footprint by a single 2.9-mm push lock anchor, followed by additional microfracturing. For follow-up, patients were evaluated according to Lysholm score, modified Cincinnati score, and Tegner activity score. Clinical examination was performed using Lachman and pivot-shift testing and range of motion and sagittal stability measurement, using a Rolimeter.
Mean follow-up was 79 (range 60 to 98) months. One patient was lost to follow-up, and 11 out of 12 patients were examined clinically. Eight patients achieved good subjective and clinical outcome. One patient suffered an early re-tear, and one patient with additional patellar tendon tear and one patient with polyarthritis demonstrated poor subjective and clinical results due to lasting instability. Seven out of 12 patients reached preoperative Tegner activity score postoperatively again. The mean Lysholm score was 85.3 points, mean subjective IKDC score was 87.3 points, and mean modified Cincinnati score was 83.8 points. Rolimeter measurements demonstrated a mean side-to-side difference of 2 (range 1-5) mm.
In the current study, primary surgical re-fixation of proximal, femoral ACL avulsion tears using single suture anchor repair resulted in good to excellent clinical mid-term outcomes. However, in cases of additional serious damage to extensor structures or systemic rheumatic disease, loss of function and unsatisfying clinical results occurred. Further prospective randomized controlled trials are necessary to confirm the encouraging long-term results of this study.
Bavarian National Medical Chamber of Physicians, file number 2016-095. German Clinical Trials ( DRKS00013059 ).
目前的研究表明，初次前交叉韧带（ACL）缝合锚钉修复术后的短期结果令人鼓舞。然而，早期研究报告称，在临床短期恢复良好后，5年随访时膝关节功能出现恶化。因此，本研究的目的是评估初次ACL修复术后至少5年随访的临床长期结果。
在一项回顾性研究中，纳入了2009年至2012年期间的13例患者。纳入标准为急性近端、股骨ACL撕脱伤，组织质量良好，且为健康、有需求的患者出现矢状面不稳定。排除患有近端胫骨骨折、关节炎或膝关节多韧带损伤的患者。使用单个2.9毫米推锁锚钉将ACL固定于骨附着点，随后进行额外的微骨折术。随访时，根据Lysholm评分、改良辛辛那提评分和Tegner活动评分对患者进行评估。使用Lachman试验和轴移试验以及使用Rolimeter测量活动范围和矢状面稳定性进行临床检查。
平均随访时间为79（范围60至98）个月。1例患者失访，12例患者中的11例接受了临床检查。8例患者取得了良好的主观和临床结果。1例患者早期再次撕裂，1例伴有髌腱撕裂的患者和1例患有多关节炎的患者因持续不稳定而表现出较差的主观和临床结果。12例患者中有7例术后再次达到术前Tegner活动评分。平均Lysholm评分为85.3分，平均主观IKDC评分为87.3分，平均改良辛辛那提评分为83.8分。Rolimeter测量显示平均左右差异为2（范围1 - 5）毫米。
在本研究中，使用单个缝合锚钉修复对近端、股骨ACL撕脱伤进行初次手术重新固定，产生了良好至优异的临床中期结果。然而，在伸肌结构出现额外严重损伤或患有全身性风湿性疾病的情况下，会出现功能丧失和临床结果不尽人意的情况。需要进一步的前瞻性随机对照试验来证实本研究令人鼓舞的长期结果。
巴伐利亚国家医师医疗商会，文件编号2016 - 095。德国临床试验（DRKS00013059）。
