Department of Orthopaedics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus, Denmark.
Knee Surg Sports Traumatol Arthrosc. 2020 Mar;28(3):881-887. doi: 10.1007/s00167-019-05535-x. Epub 2019 May 23.
The aim of this study was to compare outcome data after isolated and combined (MCL) plus anterior cruciate ligament (ACL) reconstruction based on objective and subjective measures using data from the (DKRR). There are only a few small-sized case studies on outcomes after MCL reconstruction. MCL reconstruction was hypothesised to improve both objective and subjective outcomes.
All patients who were registered in the DKRR between 2005 and 2016 (N = 25,281) and who underwent isolated ACL (n = 24,683), isolated MCL (n = 103) or combined MCL plus ACL (n = 495) reconstructions were retrospectively identified. Objective (valgus knee stability and sagittal knee laxity) and subjective (Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale score) outcomes in these three cohorts were evaluated at the 1-year follow-up by comparing pre- and post-operative values.
Medial stability improved significantly pre- to post-operatively after both isolated MCL and combined MCL plus ACL reconstruction, with 26 (53%) and 195 (69%) of the patients, respectively, having normal valgus stability (0-2 mm laxity). Sagittal stability was similar after MCL plus ACL reconstruction and isolated ACL reconstruction (1.7 and 1.5 mm, respectively). At the 1-year follow-up, although the KOOS of the patients in the isolated MCL and combined MCL plus ACL reconstruction cohorts improved significantly, they were lower than those of the patients in the isolated ACL reconstruction cohort.
Both isolated MCL reconstruction and combined MCL plus ACL reconstruction resulted in significant and clinically relevant improvements in the subjective outcomes from pre-operative conditions to the 1-year follow-up. Valgus stability also improved significantly, with two-thirds of patients obtaining normal valgus stability after MCL reconstruction. Subjective outcomes were similar between isolated MCL reconstruction and combined MCL plus ACL reconstructions, but were poorer than isolated ACL reconstructions.
Level III.
本研究旨在通过 DKRR 的数据，比较单纯前交叉韧带（ACL）重建和合并（MCL）前交叉韧带（ACL）重建的术后结果数据，对客观和主观测量指标进行分析。关于 MCL 重建后的结果，仅有少数小规模的病例研究。本研究假设 MCL 重建可改善客观和主观结果。
本回顾性研究分析了 2005 年至 2016 年期间在 DKRR 注册的所有患者的资料，共 25281 例患者接受了单纯 ACL（n=24683）、单纯 MCL（n=103）或合并 MCL 加 ACL（n=495）重建。通过比较术前和术后的数值，对这三组患者的客观（外翻膝关节稳定性和矢状位膝关节松弛度）和主观（膝关节损伤和骨关节炎结果评分（KOOS）和 Tegner 活动量表评分）结果进行评估。
单纯 MCL 和合并 MCL 加 ACL 重建后，内侧稳定性均显著改善，分别有 26（53%）和 195（69%）名患者的外翻稳定性恢复正常（0-2mm 松弛度）。MCL 加 ACL 重建和单纯 ACL 重建后矢状位稳定性相似（分别为 1.7mm 和 1.5mm）。在 1 年随访时，尽管单纯 MCL 和合并 MCL 加 ACL 重建组的患者 KOOS 显著改善，但仍低于单纯 ACL 重建组。
单纯 MCL 重建和合并 MCL 加 ACL 重建均使患者主观结果从术前状态到 1 年随访时显著改善，且具有临床意义。外翻稳定性也显著改善，三分之二的 MCL 重建患者获得了正常的外翻稳定性。单纯 MCL 重建和合并 MCL 加 ACL 重建的主观结果相似，但均不如单纯 ACL 重建。
III 级。
