From the Department of Orthopaedic Surgery (Dr. Su, Dr. Lawrence, Dr. Ganley, and Dr. Wells), University of Pennsylvania, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia (Dr. Storey and Dr. Forst), and National Yang-Ming University (Dr. Lin), Taipei, Taiwan.
J Am Acad Orthop Surg. 2018 Dec 1;26(23):e483-e489. doi: 10.5435/JAAOS-D-17-00177.
This study investigated the association of graft-related surgical factors and patient characteristics with the odds of arthrofibrosis after primary anterior cruciate ligament reconstruction (ACL-R).
A retrospective case-control study assessed consecutive patients who underwent primary ACL-R in one tertiary pediatric hospital. Each arthrofibrosis case was matched to three controls for sex, calendar year, and age at the time of ACL-R, as well as the primary surgeon. Conditional multivariable logistic regression assessed the independent association of graft diameter, time from injury to ACL-R, concomitant knee pathologies, and body mass index.
Twenty arthrofibrosis cases of 1,121 ACL-R patients (incidence 1.8%) were matched to 60 controls resulting in the mean age of 14.5 years. An increase of 1 mm graft diameter was associated with 3.2-times increased odds of arthrofibrosis. Other variables were not independently associated with arthrofibrosis.
For young patients, the decision on the graft size must consider the possibility of arthrofibrosis with a larger graft versus reinjury with a smaller graft.
本研究旨在探讨移植物相关手术因素和患者特征与初次前交叉韧带重建（ACL-R）后发生关节纤维粘连的几率之间的关系。
一项回顾性病例对照研究评估了在一家三级儿科医院接受初次 ACL-R 的连续患者。每个关节纤维粘连病例都与 3 名性别、日历年份和 ACL-R 时年龄以及主刀医生相匹配的对照组相匹配。条件多变量逻辑回归评估了移植物直径、受伤至 ACL-R 的时间、伴随的膝关节病变和体重指数的独立相关性。
20 例关节纤维粘连病例（发生率 1.8%）与 60 例对照组相匹配，平均年龄为 14.5 岁。移植物直径增加 1 毫米，发生关节纤维粘连的几率增加 3.2 倍。其他变量与关节纤维粘连无独立相关性。
对于年轻患者，在选择移植物大小时，必须考虑到较大移植物导致关节纤维粘连的可能性，与较小移植物导致再损伤的可能性。
