非手术治疗合并内侧副韧带损伤与 ACL 翻修风险增加：来自瑞典国家膝关节韧带登记处的 19457 例患者研究。
Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury: a study on 19,457 patients from the Swedish National Knee Ligament Registry.
机构信息
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2019 Aug;27(8):2450-2459. doi: 10.1007/s00167-018-5237-3. Epub 2018 Oct 29.
PURPOSE
To determine how concomitant medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries affect outcome after anterior cruciate ligament (ACL) reconstruction.
METHODS
Patients aged > 15 years who were registered in the Swedish National Knee Ligament Registry for primary ACL reconstruction between 2005 and 2016 were eligible for inclusion. Patients with a concomitant MCL or LCL injury were stratified according to collateral ligament treatment (non-surgical, repair or reconstruction), and one isolated ACL reconstruction group was created. The outcomes were ACL revision and the 2-year Knee Injury and Osteoarthritis Outcome Score (KOOS), which were analyzed using univariable and multivariable Cox regression and an analysis of covariance, respectively.
RESULTS
A total of 19,457 patients (mean age 27.9 years, 59.4% males) met the inclusion criteria. An isolated ACL reconstruction implied a lower risk of ACL revision compared with presence of a non-surgically treated MCL injury (HR = 0.61 [95% CI 0.41-0.89], p = 0.0097) but not compared with MCL repair or reconstruction. A concomitant LCL injury did not impact the risk of ACL revision. Patients with a concomitant MCL or LCL injury reported inferior 2-year KOOS compared with isolated ACL reconstruction. The largest difference was found in the sports and recreation subscale across all groups, with MCL reconstruction resulting in the maximum difference (14.1 points [95% CI 4.3-23.9], p = 0.005).
CONCLUSION
Non-surgical treatment of a concomitant MCL injury in the setting of an ACL reconstruction may increase the risk of ACL revision. However, surgical treatment of the MCL injury was associated with a worse two-year patient-reported knee function. A concomitant LCL injury does not impact the risk of ACL revision compared with an isolated ACL reconstruction.
LEVEL OF EVIDENCE
Cohort study, Level III.
目的
确定前交叉韧带（ACL）重建术后合并内侧副韧带（MCL）和外侧副韧带（LCL）损伤如何影响结果。
方法
符合条件的患者为 2005 年至 2016 年间在瑞典全国膝关节韧带登记处接受初次 ACL 重建的年龄大于 15 岁的患者。根据侧副韧带治疗（非手术、修复或重建）对合并 MCL 或 LCL 损伤的患者进行分层，并创建一个单独的 ACL 重建组。使用单变量和多变量 Cox 回归以及协方差分析分别分析结果为 ACL 翻修和 2 年膝关节损伤和骨关节炎结局评分（KOOS）。
结果
共有 19457 例患者（平均年龄 27.9 岁，59.4%为男性）符合纳入标准。与非手术治疗的 MCL 损伤相比（HR=0.61[95%CI 0.41-0.89]，p=0.0097），单独的 ACL 重建意味着 ACL 翻修的风险较低，但与 MCL 修复或重建相比则不然。合并 LCL 损伤并不影响 ACL 翻修的风险。合并 MCL 或 LCL 损伤的患者报告 2 年 KOOS 低于单独 ACL 重建。所有组中差异最大的是运动和娱乐亚量表，其中 MCL 重建导致的差异最大（14.1 分[95%CI 4.3-23.9]，p=0.005）。
结论
在 ACL 重建的情况下，MCL 损伤的非手术治疗可能会增加 ACL 翻修的风险。然而，MCL 损伤的手术治疗与较差的两年患者报告膝关节功能相关。与单独的 ACL 重建相比，合并 LCL 损伤不会增加 ACL 翻修的风险。
证据水平
队列研究，III 级。
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