缝线增强修复前交叉韧带近端撕脱伤

Anterior Cruciate Ligament Repair with Suture Augmentation for Proximal Avulsion Injuries.

作者信息

Douoguih Wiemi A, Zade Ralph T, Bodendorfer Blake M, Siddiqui Yalda, Lincoln Andrew E

机构信息

Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC.

MedStar Union Memorial Hospital, Baltimore, MD.

出版信息

Arthrosc Sports Med Rehabil. 2020 Aug 20;2(5):e475-e480. doi: 10.1016/j.asmr.2020.05.003. eCollection 2020 Oct.

DOI:10.1016/j.asmr.2020.05.003

PMID:33134983

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7588600/

Abstract

PURPOSE

To assess failure rate, outcomes, and patient satisfaction in patients who underwent anterior cruciate ligament (ACL) repair with suture augmentation for clinical instability and proximal avulsion of the ACL.

METHODS

We retrospectively reviewed consecutive suture-augmented ACL repairs performed by a single surgeon between January 2014 and June 2016 for proximal ACL avulsion. Patients were included if they were at least 24 months postoperative from repair surgery. Patients were excluded from the study if they underwent primary ACL reconstruction instead of repair or if they had a concomitant multiligamentous knee injury. Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS), Veterans RAND-12 (VR-12), Marx Activity, and Single Assessment Numeric Evaluation data were collected.

RESULTS

Of 172 patients who underwent ACL surgery between January 2014 and June 2016, 28 (16%) with Sherman type I or II ACL tears or high-grade partial avulsion with clinical instability underwent ACL repair with suture augmentation. One patient was not available for follow-up. The 27 patients were age 27.4 ± 8.6 years, 18 males (66.7%), and 2.8 ± 0.7 years follow-up (range, 2.0-3.8 years). Of these 27 patients, 4 recurrent ACL injuries (14.8%) required revision to reconstruction. The remaining 23 patients had successful ACL repair with no clinical instability and no subjective complaints at final follow-up. Final scores were KOOS 83.7 ± 12.8, Marx 8.6 ± 4.0, VAS 1.1 ± 1.8, physical VR-12 53.6 ± 5.2, mental VR-12 53.1 ± 8.1, and Single Assessment Numeric Evaluation 83.0 ± 12.9. In the 11 patients with baseline data, significant improvements were observed in composite KOOS (50.4 ± 11.5 to 85.7 ± 8.4; < .001; VAS: 3.9 ± 2.6 to 0.8 ± 0.8; = .002; and physical VR-12: 39.9 ± 6.5 to 55.5 ± 3.3; < .001). All 11 patients (100%) met or exceeded the KOOS composite minimum clinically important difference (mean 34.0 increase).

CONCLUSIONS

In patients with proximal ACL avulsion, arthroscopic primary ACL repair with suture augmentation demonstrated high functional outcome and improved patient-reported outcomes at 2-year follow-up. The rate of graft failure was 15%.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

评估因临床不稳定和前交叉韧带（ACL）近端撕脱而接受ACL缝合增强修复术患者的失败率、治疗结果及患者满意度。

方法

我们回顾性分析了2014年1月至2016年6月间由同一位外科医生连续进行的ACL近端撕脱缝合增强修复术。纳入术后至少24个月的患者。若患者接受的是初次ACL重建而非修复手术，或伴有膝关节多韧带损伤，则排除在本研究之外。收集膝关节损伤和骨关节炎疗效评分（KOOS）、视觉模拟量表（VAS）、退伍军人兰德12项健康调查简表（VR-12）、马克思活动量表及单项评估数值评定数据。

结果

在2014年1月至2016年6月期间接受ACL手术的172例患者中，28例（16%）Sherman I型或II型ACL撕裂或伴有临床不稳定的高度部分撕脱患者接受了ACL缝合增强修复术。1例患者无法进行随访。27例患者年龄为27.4±8.6岁，男性18例（66.7%），随访时间为2.8±0.7年（范围2.0 - 3.8年）。这27例患者中，4例（14.8%）复发性ACL损伤需要翻修为重建手术。其余23例患者ACL修复成功，末次随访时无临床不稳定且无主观不适。末次评分：KOOS为83.7±12.8，马克思量表为8.6±4.0，VAS为1.1±1.8，身体功能VR-12为53.6±5.2，精神健康VR-12为53.1±8.1，单项评估数值评定为83.0±12.9。在有基线数据的11例患者中，KOOS综合评分有显著改善（从50.4±11.5提高到85.7±8.4；P<0.001）；VAS评分（从3.9±2.6降至0.8±0.8；P = 0.002）；身体功能VR-12评分（从39.9±6.5提高到55.5±3.3；P<0.001）。所有11例患者（100%）均达到或超过KOOS综合评分的最小临床重要差异（平均提高34.0）。