Diermeier Theresa, Herbst Elmar, Braun Sepp, Saracuz Emine, Voss Andreas, Imhoff Andreas B, Achtnich Andrea
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, TU Munich, Ismaninger Str. 22, 81675, Munich, Germany.
BMC Musculoskelet Disord. 2018 Jul 21;19(1):246. doi: 10.1186/s12891-018-2174-8.
Current literature is lacking of data regarding functional outcomes in patients following bone tunnel grafting with or without revision anterior cruciate ligament (ACL) reconstruction. Therefore, the aim of the present study was to evaluate the clinical outcome in patients with (RACL) or without revision ACL reconstruction (OBG) following bone grafting.
Fifty-nine patients (18 female, 41 male) who underwent bone grafting due to recurrent, symptomatic ACL deficiency following ACL reconstruction between 2011 and 2014 were retrospectively analyzed. In 44 patients (mean age: 30,5 ± 8,5 years) a staged revision ACL reconstruction (RACL) was performed after bone grafting. 10 patients (mean age: 33.2 ± 10.3 years) refused to have ACL revision surgery after bone grafting (OBG). Outcome measures included instrumented laxity testing, the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score and Tegner activity scale.
After mean period of 33,9 ± 17.0 months, 54 patients were available for follow up examination. In the RACL group, the Lysholm score was 77,2 ± 15,5 (range 35-100), the mean IKDC subjective knee score was 69,0 ± 13,4 (range 39,1-97,7) and the mean Tegner activity score was 4,1 ± 1,5 (range, 1-9). Similarly, in the OBG group the mean Lysholm score was 72,90 ± 18,7 (range 50-100), the mean IKDC subjective score was 69,3 ± 20,0 (range 44,1-100) and the mean Tegner activity score was 4,6 ± 1,2 (range, 3-6). No significant difference was observed between the two groups. Knee laxity measurements were elevated without revision ACL surgery, however the difference was not significant.
Bone tunnel grafting with or without second stage ACL revision surgery showed no significant difference in functional outcome score. Thus, in case of revision ACL instability careful patient selection is necessary and expectations should be discussed openly with the patients.
目前的文献缺乏关于接受或未接受前交叉韧带（ACL）翻修重建的骨隧道移植患者功能结局的数据。因此，本研究的目的是评估接受翻修ACL重建（RACL）或未接受翻修ACL重建（OBG）的骨移植患者的临床结局。
回顾性分析了2011年至2014年间因ACL重建术后复发性、有症状的ACL缺损而接受骨移植的59例患者（18例女性，41例男性）。44例患者（平均年龄：30.5±8.5岁）在骨移植后进行了分期翻修ACL重建（RACL）。10例患者（平均年龄：33.2±10.3岁）在骨移植后拒绝进行ACL翻修手术（OBG）。结局指标包括仪器化松弛度测试、国际膝关节文献委员会（IKDC）评分、膝关节损伤和骨关节炎结局评分（KOOS）、Lysholm评分和Tegner活动量表。
平均33.9±17.0个月后，54例患者可进行随访检查。在RACL组中，Lysholm评分为77.2±15.5（范围35 - 100），平均IKDC主观膝关节评分为69.0±13.4（范围39.1 - 97.7），平均Tegner活动评分为4.1±1.5（范围1 - 9）。同样，在OBG组中，平均Lysholm评分为72.90±18.7（范围50 - 100），平均IKDC主观评分为69.3±20.0（范围44.1 - 100），平均Tegner活动评分为4.6±1.2（范围3 - 6）。两组之间未观察到显著差异。未进行ACL翻修手术时膝关节松弛度测量值升高，但差异不显著。
进行或不进行二期ACL翻修手术的骨隧道移植在功能结局评分上无显著差异。因此，对于ACL翻修不稳定的情况，需要仔细选择患者，并应与患者公开讨论预期结果。
