Canberra Orthopaedics and Sports Medicine, Bruce, Australian Capital Territory, Australia.
Canberra Hospital, Garran, Australian Capital Territory, Australia.
Am J Sports Med. 2020 Apr;48(5):1069-1077. doi: 10.1177/0363546520910148. Epub 2020 Mar 17.
The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain.
To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift.
Randomized controlled trial; Level of evidence, 2.
Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures ( < .05).
A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; = .99) relative to group B.
The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores.
ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry).
前交叉韧带（ACL）重建中添加前外侧软组织增强的适应证及其有效性仍不确定。
确定改良髂胫束止点重建（MITBT）是否可以改善临床结果并降低 ACL 重建后残留前抽屉试验阳性患者 ACL 再次断裂的发生率。
随机对照试验；证据等级，2 级。
纳入满足以下纳入标准的初次 ACL 断裂患者：初次 ACL 断裂，参与旋转运动，骨骼成熟，未行半月板修复，ACL 重建后即刻与对侧未受伤膝关节相比存在残留前抽屉试验阳性。患者被随机分配到 A 组（不进行进一步手术）或 B 组（增加 MITBT），并随访 2 年。使用的患者报告结局（PRO）测量包括国际膝关节文献委员会（IKDC）评分、膝关节损伤和骨关节炎结局评分（KOOS）运动/娱乐亚量表（Sport/Rec）、KOOS 生活质量亚量表（QoL）、Lysholm 膝关节评分（LKS）、Tegner 活动量表（TAS）、ACL 再次断裂或任何膝关节需要进一步手术。使用方差分析比较 PRO；使用 Wilcoxon 检验比较 TAS；使用卡方检验比较 ACL 再次断裂、半月板损伤和对侧 ACL 断裂的发生率（<0.05）。
共随机分配了 55 名患者：A 组 27 名（女性：男性比例=15：12；平均年龄 22.3±3.7 岁），B 组 28 名（女性：男性比例=17：11；平均年龄 21.8±4.1 岁）。在 2 年随访时，A 组的 IKDC 评分相似（90.9±10.7 与 94.2±11.2；=0.21），KOOS Sport/Rec 评分较低（91.5±6.4 与 95.3±4.4；=0.02），KOOS QoL 评分相似（92.0±4.8 与 95.1±4.3；=0.14），LKS 评分较低（92.5±4.8 与 96.8±8.0；=0.004），TAS 评分较低（中位数，7[范围，7-9]与 8[范围，8-10]；=0.03），ACL 再次断裂的发生率较高（14.8%与 0.0%；<0.001），半月板撕裂的发生率相似（14.8%与 3.6%；=0.14），对侧 ACL 断裂的发生率相似（3.7%与 3.6%；=0.99）。
ACL 重建中增加 MITBT 可降低 ACL 重建后残留前抽屉试验阳性膝关节 ACL 再次断裂的风险，并改善 KOOS Sport/Rec、LKS 和 TAS 评分。
ACTRN12618001043224（澳大利亚和新西兰临床试验注册中心）。
