前交叉韧带重建术后的长期结果。
The Long-Term Outcome After Early and Late Anterior Cruciate Ligament Reconstruction.
机构信息
Department of Orthopaedics, NU Hospital Group, Trollhättan/Uddevalla, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Hand Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
出版信息
Arthroscopy. 2018 Jun;34(6):1907-1917. doi: 10.1016/j.arthro.2018.01.026. Epub 2018 Mar 6.
PURPOSE
To compare long-term clinical and radiographic outcomes in patients undergoing either early (group A) or late (group B) surgery after anterior cruciate ligament (ACL) injury.
METHODS
ACL reconstruction using hamstring tendon autografts was performed in 30 patients in group A (median age, 23 years; range, 17-49 years) and 31 patients in group B (median age, 27 years; range, 17-38 years). The patients in group A were operated on within 5 months (median, 3 months; range, 2-5 months) of injury, whereas those in group B were operated on more than 24 months (median, 30 months; range, 24-48 months) after injury. The follow-up period was 10 years (median, 117 months [range, 77-222 months] in group A and 129 months [range, 77-206 months] in group B; P = .44). Multiple objective clinical evaluation tests and patient-reported outcome measures were obtained preoperatively and at follow-up. At follow-up, radiographic assessments of knee osteoarthritis (OA) bilaterally were performed.
RESULTS
The frequency of meniscectomy at the index operation was significantly lower in group A (20%) than in group B (52%) (P = .01). There were no significant differences between the groups in terms of Tegner and Lysholm scores and laxity tests both preoperatively and at follow-up. Both groups improved over time in terms of Tegner and Lysholm scores (P < .05). At follow-up, significantly more medial-compartment OA in the index knee was found in group B than in group A (P = .037) according to the Ahlbäck classification system. The index knee showed significantly more OA than the contralateral knee in both groups (P < .01).
CONCLUSIONS
Patients who underwent early ACL reconstruction required significantly fewer meniscectomies at the index operation than patients who underwent late reconstruction and showed significantly less OA on the medial side of the knee 10 years after reconstruction. However, no significant differences were found between the groups in terms of clinical assessments.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
比较前交叉韧带（ACL）损伤后行早期（A 组）或晚期（B 组）手术患者的长期临床和影像学结果。
方法
30 例 A 组（平均年龄 23 岁；范围 17-49 岁）和 31 例 B 组（平均年龄 27 岁；范围 17-38 岁）患者行 ACL 重建术，均使用自体腘绳肌腱。A 组患者在损伤后 5 个月内（平均 3 个月；范围 2-5 个月）手术，B 组患者在损伤后 24 个月以上（平均 30 个月；范围 24-48 个月）手术。随访时间为 10 年（A 组中位数 117 个月[范围 77-222 个月]，B 组中位数 129 个月[范围 77-206 个月]；P=.44）。术前和随访时进行多项客观临床评估测试和患者报告的结果测量。随访时，双侧膝关节行放射学评估，以判断骨关节炎（OA）。
结果
A 组（20%）索引手术时行半月板切除术的频率明显低于 B 组（52%）（P=.01）。两组患者术前及随访时的 Tegner 和 Lysholm 评分及松弛度检查均无统计学差异。两组患者的 Tegner 和 Lysholm 评分均随时间改善（P<.05）。随访时，根据 Ahlbäck 分类系统，B 组患者的内侧间室 OA 明显多于 A 组（P=.037）。两组患者的患侧膝关节较健侧膝关节均有明显更多的 OA（P<.01）。
结论
早期行 ACL 重建的患者在索引手术时需要行半月板切除术的频率明显低于晚期重建的患者，且重建后 10 年膝关节内侧的 OA 明显较少。然而，两组患者的临床评估结果无显著差异。
证据水平
III 级，回顾性比较研究。
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