Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea.
Department of Orthopaedic Surgery, Korea University Ansan Hospital, Gyeongki-do, Korea.
J Knee Surg. 2021 Oct;34(12):1310-1317. doi: 10.1055/s-0040-1708055. Epub 2020 May 5.
This study aimed to investigate the effect of anterolateral ligament reconstruction (ALLR) in revision anterior cruciate ligament reconstruction (ACLR) with high-grade pivot shift. The hypothesis was that revision ACLR combined with ALLR (RACLR with ALLR group) would show superior clinical outcomes to those of isolated revision ACLR. We retrospectively evaluated consecutive patients who underwent revision ACLR (RACLR) combined with ALLR between October 2015 and January 2017. The indication for combination of ALLR with revision ACLR was failed ACLR with ≥G2 pivot-shift instability. The control group included patients who underwent isolated revision ACLR (isolated RACLR group) for the same indication between July 2013 and September 2015. Exclusion criteria were ≤G1 pivot-shift instability, multiple ligament reconstruction, bilateral ligament injury, double-bundle reconstruction, insufficient medical records, postoperative infection, and follow-up loss at postoperative 2 years. Clinical scores, stability tests, and failure rates were compared between groups at the 2-year follow-up. The RACLR with ALLR group had 18 patients (mean age, 32.9 ± 10.8 years) and the RACLR group had 21 patients (mean age, 29.6 ± 10.2 years). Clinical scores at the 2-year follow-up showed no significant differences between groups. However, the RACLR with ALLR group showed better stability in the Lachman test ( = 0.005), pivot-shift test ( = 0.030), and side-to-side difference in stress radiographs (3.9 ± 3.0 mm vs. 5.9 ± 2.8 mm, = 0.018) than the isolated RACLR group. The RACLR with ALLR group had two failures (11.1%), and the RACLR group had three failures (14.3%). In conclusion, ALLR in revision ACLR with high-grade pivot shift improves anteroposterior stability as well as rotational stability at 2-year follow-up. Therefore, ALLR is recommended with revision ACLR, especially in patients with high-grade pivot shift. This is a Level III, retrospective cohort review.
本研究旨在探讨前外侧韧带重建（ALLR）在伴有高级别轴移的前交叉韧带重建（ACLR）翻修中的作用。假设在 ACLR 翻修中联合 ALLR（RACLR 联合 ALLR 组）的临床效果优于单独 ACLR 翻修。我们回顾性评估了 2015 年 10 月至 2017 年 1 月期间接受 ACLR 翻修（RACLR）联合 ALLR 的连续患者。联合 ALLR 进行 ACLR 翻修的指征为 ACLR 失败伴≥G2 轴移不稳定。对照组包括 2013 年 7 月至 2015 年 9 月期间因同一指征接受单纯 ACLR 翻修（单纯 RACLR 组）的患者。排除标准为≤G1 轴移不稳定、多韧带重建、双侧韧带损伤、双束重建、病历资料不全、术后感染和术后 2 年随访丢失。在 2 年随访时比较两组的临床评分、稳定性试验和失败率。RACLR 联合 ALLR 组 18 例（平均年龄 32.9±10.8 岁），RACLR 组 21 例（平均年龄 29.6±10.2 岁）。2 年随访时，两组的临床评分无显著差异。然而，RACLR 联合 ALLR 组在 Lachman 试验（ = 0.005）、轴移试验（ = 0.030）和应力位 X 线片的侧-侧差值方面表现出更好的稳定性（3.9±3.0 mm 比 5.9±2.8 mm， = 0.018）。RACLR 联合 ALLR 组有 2 例失败（11.1%），RACLR 组有 3 例失败（14.3%）。总之，在伴有高级别轴移的 ACLR 翻修中进行 ALLR 可改善前后向稳定性和旋转稳定性，在 2 年随访时。因此，建议在 ACLR 翻修中使用 ALLR，特别是在伴有高级别轴移的患者中。这是一项 III 级回顾性队列研究。
