Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Knee Surg Sports Traumatol Arthrosc. 2018 Dec;26(12):3652-3659. doi: 10.1007/s00167-018-4934-2. Epub 2018 Apr 2.
To evaluate the results of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction in patients with chronic ACL injury. It was hypothesized that patients who underwent combined ACL and ALL reconstruction would exhibit less residual laxity and better clinical outcomes.
Two groups of patients were evaluated and compared retrospectively. Both groups consisted only of patients with chronic (more than 12 months) ACL injuries. Patients in group 1 underwent anatomical intra-articular reconstruction of the ACL and patients in group 2 underwent anatomic intra-articular ACL reconstruction combined with ALL reconstruction. The presence of associated meniscal injury, the subjective International Knee Documentation Committee (IKDC) and Lysholm functional outcome scores in the postoperative period, KT-1000 evaluation, the presence of residual pivot shift and graft rupture rate were evaluated.
One hundred and one patients who underwent reconstruction of chronic ACL injuries were evaluated. The median follow-up was 26 (24-29) months for group 1 and 25 (24-28) months for group 2. There were no significant differences between groups regarding gender, age, duration of injury until reconstruction, follow-up time or presence of associated meniscal injuries in the preoperative period. Regarding functional outcome scores, patients in group 2 presented better results on both the IKDC (p = 0.0013) and the Lysholm (p < 0.0001) evaluations. In addition, patients in group 2 had better KT-1000 evaluation (p = 0.048) and a lower pivot shift rate at physical examination, presenting only 9.1% positivity versus 35.3% in the isolated ACL reconstruction (p = 0.011). Regarding re-ruptures, group 1 presented 5 (7.3%) cases, and group 2 presented no cases.
The combined ACL and ALL reconstruction in patients with chronic ACL injury is an effective and safety solution and leads to good functional outcomes with no increase in complication rate. The clinical relevance of this finding is the possibility to indicate this type of procedure when patients present with more than 12 months after injury for surgery.
Level III.
评估慢性前交叉韧带（ACL）损伤患者进行前交叉韧带（ACL）和前外侧韧带（ALL）联合重建的结果。假设接受 ACL 和 ALL 联合重建的患者残余松弛度较低，临床结果更好。
回顾性评估和比较两组患者。两组均仅由慢性（超过 12 个月）ACL 损伤患者组成。第 1 组患者接受 ACL 的解剖关节内重建，第 2 组患者接受解剖关节内 ACL 重建联合 ALL 重建。评估存在相关半月板损伤、术后国际膝关节文献委员会（IKDC）和 Lysholm 功能评分、KT-1000 评估、残余旋转不稳定和移植物断裂率。
共评估了 101 例慢性 ACL 损伤重建患者。第 1 组的中位随访时间为 26（24-29）个月，第 2 组为 25（24-28）个月。两组在性别、年龄、受伤至重建时间、随访时间或术前存在相关半月板损伤方面无显著差异。在功能评分方面，第 2 组患者在 IKDC（p=0.0013）和 Lysholm（p<0.0001）评估中均有更好的结果。此外，第 2 组患者的 KT-1000 评估更好（p=0.048），体检时旋转不稳定率更低，仅 9.1%为阳性，而单独 ACL 重建为 35.3%（p=0.011）。关于再断裂，第 1 组有 5 例（7.3%），第 2 组无病例。
慢性 ACL 损伤患者的 ACL 和 ALL 联合重建是一种有效且安全的解决方案，可带来良好的功能结果，且并发症发生率无增加。这一发现的临床意义在于，当患者受伤后 12 个月以上进行手术时，可以考虑这种手术方式。
III 级。
