Department of Orthopaedic Surgery, Kyung Hee University Hospital, 23, Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-Gu, Ansan-si, Gyeongki-do, Republic of Korea.
Knee Surg Sports Traumatol Arthrosc. 2020 Jun;28(6):1909-1918. doi: 10.1007/s00167-019-05653-6. Epub 2019 Aug 5.
This study aimed to compare patient demographics, associated lesions (concurrent meniscal and chondral injuries), and clinical outcomes between revision and re-revision anterior cruciate ligament reconstructions.
Patients who underwent revision or re-revision anterior cruciate ligament reconstruction between 2008 and 2016 with a minimum 2-year follow-up were retrospectively evaluated. Detailed patient demographic data, radiographic preoperative tunnel diameters, posterior tibia slope, and concurrent meniscal and chondral lesion were reviewed. Clinical scores and laxity tests' results were compared between the groups at the last follow-up.
Eighty-two patients (mean age, 33.8 ± 9.9 years; revision group, n = 62; re-revision group, n = 20) were included. The re-revision group showed a higher grade for preoperative arthritis (P < 0.001); more severe preoperative bone defects of the femoral (13.8 ± 2.6 vs 11.7 ± 2.7 mm, P = 0.004) and tibial tunnels (14.6 ± 2.4 vs 13.0 ± 2.3 mm, P = 0.010); and a higher prevalence of subtotal medial meniscectomy (P = 0.008) and chondral defects of the medial (P = 0.006) and lateral femoral condyles (P < 0.001), patella (P = 0.040), and trochlea (P = 0.036). At the final follow-up, the clinical scores did not differ significantly between the groups. However, the re-revision group showed more instability in the anterior drawer (P = 0.001), Lachman (P < 0.001), and pivot-shift (P < 0.001) tests, while a side-to-side difference was observed on the Telos stress radiographs (7.1 ± 4.7 vs 4.9 ± 3.7 mm, P = 0.038).
These findings showed that the patients who underwent re-revision had poor prognostic factors as compared with those who underwent revision anterior cruciate ligament reconstruction. Although the clinical scores did not differ significantly between the groups, the re-revision group showed more laxity at the 2-year follow-up.
Cohort study; IV.
本研究旨在比较初次和翻修后前交叉韧带重建术患者的人口统计学特征、合并损伤（同时存在半月板和软骨损伤）以及临床结果。
回顾性分析了 2008 年至 2016 年间接受初次和翻修后前交叉韧带重建术的患者，所有患者均随访至少 2 年。对患者的详细人口统计学数据、术前隧道的 X 线直径、胫骨后倾角、同时存在的半月板和软骨损伤进行了评估。末次随访时比较了两组的临床评分和松弛度试验结果。
共纳入 82 例患者（平均年龄 33.8±9.9 岁；初次重建组 62 例，翻修组 20 例）。翻修组术前关节炎分级更高（P＜0.001）；股骨（13.8±2.6 比 11.7±2.7mm，P=0.004）和胫骨隧道（14.6±2.4 比 13.0±2.3mm，P=0.010）的术前骨缺损更严重；内侧半月板部分切除术（P=0.008）和内侧（P=0.006）、外侧股骨髁（P＜0.001）、髌骨（P=0.040）和滑车（P=0.036）软骨损伤的发生率更高。末次随访时，两组的临床评分无显著差异。然而，翻修组在前抽屉试验（P=0.001）、Lachman 试验（P＜0.001）和髌股关节旋转不稳定试验（P＜0.001）中更不稳定，而 Telos 应力 X 线片上出现侧方间隙（7.1±4.7 比 4.9±3.7mm，P=0.038）。
与初次前交叉韧带重建术患者相比，翻修患者的预后因素较差。尽管两组间临床评分无显著差异，但翻修组在 2 年随访时更松弛。
队列研究；IV 级。
