Taketomi Shuji, Inui Hiroshi, Yamagami Ryota, Kawaguchi Kohei, Nakazato Keiu, Kono Kenichi, Kawata Manabu, Nakagawa Takumi, Tanaka Sakae
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
J Orthop Sci. 2018 May;23(3):546-551. doi: 10.1016/j.jos.2018.02.006. Epub 2018 Mar 2.
The purpose of this study was to analyze the association between the prevalence of meniscal and chondral lesions and the timing of surgery in patients undergoing primary anterior cruciate ligament (ACL) reconstruction to determine a safe time for surgery.
This retrospective study involved 226 patients (91 females and 135 males; median age, 29 years) undergoing primary ACL reconstruction. Time interval from ACL injury to surgery (median, 4 months; range, 1-420 months) and concomitant meniscal and cartilage lesions in ACL reconstruction were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine the precise threshold interval to surgery to prevent meniscal or cartilage lesions. The risk of lesion occurrence after each cutoff period was determined using odds ratio (OR).
The incidences of medial meniscus (MM), lateral meniscus (LM), and cartilage lesions were 43.8%, 32.7%, and 27.4%, respectively. ROC analysis revealed that patients who waited for more than 6, 4, and 5 months for ACL reconstruction had a significantly greater risk of associated MM, LM, and chondral lesions, respectively. Patients who underwent ACL reconstruction ≥7 months after injury had OR of 4.1 (p < 0.001) for the presence of MM lesion as compared with those who underwent reconstruction within 6 months. Similarly, patients who underwent ACL reconstruction ≥5 months after injury had OR of 1.9 (p = 0.023) for the presence of LM lesion as compared with those who underwent reconstruction within 4 months, and patients who underwent ACL reconstruction ≥6 months after injury had OR of 2.9 (p < 0.001) for chondral lesion as compared with those who underwent reconstruction within 6 months.
ACL reconstruction should be performed within approximately 6 months after the injury to prevent associated meniscal or chondral lesions.
本研究旨在分析初次前交叉韧带（ACL）重建患者半月板和软骨损伤的患病率与手术时机之间的关联，以确定安全的手术时间。
这项回顾性研究纳入了226例行初次ACL重建的患者（91例女性，135例男性；中位年龄29岁）。回顾了从ACL损伤到手术的时间间隔（中位时间4个月；范围1 - 420个月）以及ACL重建术中伴随的半月板和软骨损伤情况。采用受试者工作特征（ROC）曲线分析来确定预防半月板或软骨损伤的精确手术阈值间隔。使用优势比（OR）确定每个截断期后损伤发生的风险。
内侧半月板（MM）、外侧半月板（LM）和软骨损伤的发生率分别为43.8%、32.7%和27.4%。ROC分析显示，ACL重建等待超过6、4和5个月的患者分别发生相关MM、LM和软骨损伤的风险显著更高。与伤后6个月内行重建的患者相比，伤后≥7个月行ACL重建的患者发生MM损伤的OR为4.1（p < 0.001）。同样，与伤后4个月内行重建的患者相比，伤后≥5个月行ACL重建的患者发生LM损伤的OR为1.9（p = 0.023），与伤后6个月内行重建的患者相比，伤后≥6个月行ACL重建的患者发生软骨损伤的OR为2.9（p < 0.001）。
ACL重建应在损伤后约6个月内进行，以预防相关的半月板或软骨损伤。
