Department of Orthopedic Surgery & Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Orthopedic Surgery & Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A..
Arthroscopy. 2018 Mar;34(3):736-744.e3. doi: 10.1016/j.arthro.2017.09.022. Epub 2017 Dec 19.
To (1) assess clinical outcomes of revision multiligament knee injury (MLKI) reconstruction at a minimum of 2 years' follow-up and (2) present a standardized treatment algorithm used in treating revision MLKI patients.
A retrospective review of our institution's MLKI database was performed to identify all patients who underwent revision MLKI reconstructions (≥2 ligaments reconstructed) after implementation of a standardized treatment algorithm in 2000 and had a minimum of 2 years' follow-up. Patient demographic information, injury description (mechanism of injury, neurovascular status, knee dislocation grade, associated chondral or meniscal injury), surgical technique (repair vs reconstruction, staged vs nonstaged, concomitant procedures), mechanism of failure, knee stability, and range of motion, as well as International Knee Documentation Committee and Lysholm scores, were obtained.
We assessed 23 patients (8 female and 15 male patients), with an average age of 26.7 ± 11.5 years at primary surgery and 30.8 ± 11.0 years at revision surgery. The mean follow-up period was 7.5 ± 5.3 years. Of the 23 patients, 10 (43.4%) underwent staged revision procedures: isolated bone grafting in 3, osteotomy in 4, hardware removal with osteochondral allograft in 1, hardware removal with bone grafting in 1, and meniscus repair for a locked knee in 1. The average International Knee Documentation Committee and Lysholm scores were 74.5 ± 22.3 and 79.4 ± 20.2, respectively. High-energy injury and increasing age at revision surgery were the only risk factors found to be associated with significantly worse outcomes (P < .05).
Patients with recurrent instability after MLKI reconstruction present with many concomitant pathologies, including limb malalignment, bone tunnel widening, retained hardware, meniscal incompetence, and cartilage defects. Revision MLKI reconstruction can provide these patients with modest functional outcomes when a standardized treatment algorithm is used focusing on identification and treatment of the concomitant pathology, often in a staged manner.
Level IV, case series.
（1）评估至少 2 年随访的复发性多韧带膝关节损伤（MLKI）重建的临床结果，（2）提出用于治疗复发性 MLKI 患者的标准化治疗算法。
对本机构的 MLKI 数据库进行回顾性分析，以确定在 2000 年实施标准化治疗算法后接受至少 2 条韧带重建（≥2 条韧带重建）并进行至少 2 年随访的所有复发性 MLKI 重建患者。获取患者的人口统计学信息、损伤描述（损伤机制、神经血管状态、膝关节脱位程度、伴发的软骨或半月板损伤）、手术技术（修复与重建、分期与非分期、同时进行的手术）、失败机制、膝关节稳定性和活动范围以及国际膝关节文献委员会（International Knee Documentation Committee，IKDC）和 Lysholm 评分。
我们评估了 23 名患者（8 名女性和 15 名男性患者），初次手术时的平均年龄为 26.7 ± 11.5 岁，翻修手术时的平均年龄为 30.8 ± 11.0 岁。平均随访时间为 7.5 ± 5.3 年。23 名患者中，10 名（43.4%）接受分期翻修手术：3 例行单纯骨移植，4 例行截骨术，1 例行内固定取出联合骨软骨同种异体移植，1 例行内固定取出联合植骨，1 例行锁定膝关节半月板修复术。IKDC 和 Lysholm 评分的平均得分分别为 74.5 ± 22.3 和 79.4 ± 20.2。高能量损伤和翻修手术时的年龄增加是与结局显著恶化相关的唯一危险因素（P <.05）。
复发性 MLKI 重建后出现不稳定的患者常伴有多种并存疾病，包括肢体对线不良、骨隧道增宽、残留内固定物、半月板功能不全和软骨缺损。使用标准化治疗算法，重点关注并存疾病的识别和治疗，通常采用分期方法，可为这些患者提供适度的功能结果。
IV 级，病例系列研究。
