Perrone Gabriel S, Webster Kate E, Imbriaco Chris, Portilla Gabriela M, Vairagade Amishi, Murray Martha M, Kiapour Ata M
Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
School of Medicine, Tufts University, Boston, Massachusetts, USA.
Orthop J Sports Med. 2019 Nov 12;7(11):2325967119879880. doi: 10.1177/2325967119879880. eCollection 2019 Nov.
There is a high incidence of a secondary anterior cruciate ligament (ACL) injury in unbraced adolescent athletes. Little is known about the effect of functional bracing with regard to the risk of secondary ACL injuries among adolescents.
Our primary hypothesis was that adolescents would have a high rate of secondary ACL injury even with brace use. A secondary hypothesis was that the reinjury rate with brace use would be lower than that of a historical control group of unbraced patients.
Case series; Level of evidence, 4.
A group of 219 patients (age <20 years at surgery) who underwent ACL reconstruction and were prescribed postoperative functional bracing during cutting and pivoting sports for 2 years after surgery completed a survey regarding reinjury to either knee. Rates of knee injuries following ACL reconstruction were calculated and compared with those reported in a similar unbraced cohort. The effect of demographic and anatomic factors on risk of secondary ACL injuries was also investigated.
The overall follow-up rate was 65% (142/219) at a mean 5.6 years after surgery. In the braced cohort, the overall graft retear rate was 10%, with the highest retear rates observed in male patients 17 years of age and younger (18%). The overall contralateral ACL injury and combined (graft or contralateral ACL) secondary injury rates were 13% and 23%, respectively, with female patients younger than 18 years having the highest contralateral and combined injury rates (17% and 26%, respectively). Younger age (odds ratio [OR], 0.70; = .021), family history of ACL injury (OR, 2.81; = .015), and higher lateral tibial slope (OR, 1.25; = .016) were associated with increased risk of secondary knee injury in the braced cohort. Compared with the unbraced cohort, the braced cohort had a lower overall graft retear rate ( = .028), a lower graft retear rate in patients younger than 18 years ( = .012), lower early graft retear rate (within the first year after surgery) ( = .011), and lower early graft retear rate in subjects younger than 18 years ( = .003).
Postoperative use of functional bracing can result in reduced risk of graft retear and no change in contralateral injury rates. Clinicians may want to consider the use of postoperative functional bracing in adolescent patients.
未佩戴支具的青少年运动员二次前交叉韧带（ACL）损伤的发生率较高。关于功能性支具对青少年二次ACL损伤风险的影响，人们了解甚少。
我们的主要假设是，即使使用支具，青少年二次ACL损伤的发生率也会很高。次要假设是，使用支具的再损伤率低于未佩戴支具的历史对照组患者。
病例系列；证据等级，4级。
一组219例患者（手术时年龄<20岁）接受了ACL重建，并在术后两年的切削和旋转运动中被规定使用术后功能性支具，他们完成了一项关于任一膝关节再损伤的调查。计算ACL重建术后的膝关节损伤率，并与在类似的未佩戴支具队列中报告的损伤率进行比较。还研究了人口统计学和解剖学因素对二次ACL损伤风险的影响。
术后平均5.6年时的总体随访率为65%（142/219）。在佩戴支具的队列中，总体移植物再撕裂率为10%；在17岁及以下男性患者中观察到最高的再撕裂率（18%）。总体对侧ACL损伤率和联合（移植物或对侧ACL）二次损伤率分别为13%和23%，18岁以下女性患者对侧和联合损伤率最高（分别为17%和26%）。年龄较小（优势比[OR]为0.70；P = 0.021）、ACL损伤家族史（OR为2.81；P = 0.015）和较高的胫骨外侧坡度（OR为1.25；P = 0.016）与佩戴支具队列中二次膝关节损伤风险增加相关。与未佩戴支具的队列相比，佩戴支具的队列总体移植物再撕裂率较低（P = 0.028），18岁以下患者的移植物再撕裂率较低（P = 0.012），早期移植物再撕裂率（术后第一年内）较低（P = 0.011），18岁以下受试者的早期移植物再撕裂率较低（P = 0.003）。
术后使用功能性支具可降低移植物再撕裂风险，且对侧损伤率无变化。临床医生可能需要考虑在青少年患者中使用术后功能性支具。
