Antosh Ivan J, Patzkowski Jeanne C, Racusin Adam W, Aden James K, Waterman Scott M
Dwight D. Eisenhower Army Medical Center, 300 E Hospital Rd, Ft. Gordon, GA 30905.
Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
Mil Med. 2018 Jan 1;183(1-2):e83-e89. doi: 10.1093/milmed/usx007.
Return to play and risk factors for functional limitations have been widely reported among athletes following anterior cruciate ligament reconstruction (ACLR) but has not been well studied in the military population.
We conducted a retrospective review of all active duty service members who underwent primary ACLR at our institution between 2005 and 2010. The primary endpoints evaluated included Medical Evaluation Board (MEB) and activity limitations as noted by permanent profile (PP) following surgery. Demographic and surgical information was collected including age, gender, Military Occupational Specialty, tobacco use, rank, associated meniscal/chondral injuries, graft type, graft size, graft failure, and subsequent surgeries. All patients were greater than 2 yr postoperatively from index ACLR.
A total of 470 patients met inclusion criteria for the study. There were 428 men and 42 women with a mean age of 28.5 yr. Of the 470 patients, 247 (52.6%) required either MEB, PP, or both following surgery; 129 (27.4%) required a PP only; 53 (11.3%) required a MEB only; and 65 (13.8%) required both PP and MEB following surgery. Only 223 patients (47.4%) returned to full duty without restrictions following ACLR. Both anterior cruciate ligament graft failure and subsequent surgeries were found to be statistically significant predictors for PP and/or MEB (p < 0.0001). Age, tobacco use, rank, associated meniscal/chondral injury, graft type, and graft size were not found to be significant predictors for subsequent PP and/or MEB. Female gender trended toward significance as a risk factor with 27 of 41 females (65.9%) requiring PP and/or MEB (p = 0.07). Service members in a noncombat arms role were more likely to require PP and/or MEB than those in a combat arms role (p = 0.03).
Return to full duty following ACLR in active duty soldiers is lower than may be expected. More than 50% of service members have activity limitations or are unable to return to duty following surgery. These findings allow for preoperative discussion of expected outcome and the possibility that an anterior cruciate ligament tear even when reconstructed can lead to permanent military activity limitations and MEB.
前交叉韧带重建（ACLR）术后运动员恢复运动及功能受限的风险因素已有广泛报道，但在军人中尚未得到充分研究。
我们对2005年至2010年在我院接受初次ACLR的所有现役军人进行了回顾性研究。评估的主要终点包括术后医疗评估委员会（MEB）评估结果及根据长期病历（PP）记录的活动受限情况。收集了人口统计学和手术信息，包括年龄、性别、军事职业专长、吸烟情况、军衔、合并的半月板/软骨损伤、移植物类型、移植物大小、移植物失败情况及后续手术。所有患者自初次ACLR术后均已超过2年。
共有470例患者符合研究纳入标准。其中男性428例，女性42例，平均年龄28.5岁。470例患者中，247例（52.6%）术后需要MEB评估、PP记录或两者皆需；129例（27.4%）仅需PP记录；53例（11.3%）仅需MEB评估；65例（13.8%）术后既需PP记录又需MEB评估。ACLR术后仅有223例患者（47.4%）无限制地恢复了全职工作。前交叉韧带移植物失败及后续手术均被发现是PP和/或MEB的统计学显著预测因素（p < 0.0001）。年龄、吸烟情况、军衔、合并的半月板/软骨损伤、移植物类型及移植物大小未被发现是后续PP和/或MEB的显著预测因素。女性作为风险因素有显著趋势，41例女性中有27例（65.9%）需要PP和/或MEB评估（p = 0.07）。非战斗兵种的军人比战斗兵种的军人更有可能需要PP和/或MEB评估（p = 0.03）。
现役军人ACLR术后恢复全职工作的比例低于预期。超过50%的军人术后存在活动受限或无法恢复工作。这些发现有助于术前讨论预期结果以及即使重建前交叉韧带撕裂仍可能导致永久性军事活动受限和MEB评估的可能性。
