单束前交叉韧带重建与双束前交叉韧带重建联合外侧关节外肌腱固定术的回顾性比较。

A Retrospective Comparison of Single-Bundle Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis With Double-Bundle Anterior Cruciate Ligament Reconstruction.

机构信息

Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Gyeonggido, Republic of Korea.

出版信息

Arthroscopy. 2021 Mar;37(3):976-984. doi: 10.1016/j.arthro.2020.11.011. Epub 2020 Nov 12.

DOI:10.1016/j.arthro.2020.11.011

PMID:33188853

Abstract

PURPOSE

To compare postoperative objective knee stability and clinical outcomes between double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) and single-bundle (SB) ACLR combined with lateral extra-articular tenodesis (LET).

METHODS

ACL-injured patients with grade 3 pivot-shift who underwent either DB ACLR (DB ACLR group) or SB ACLR with LET (SB ACLR+LET group) were enrolled. All patients who met inclusion and exclusion criteria were retrospectively evaluated for knee laxity (the anterior translation and pivot-shift grade), clinical outcomes using the International Knee Documentation Committee (IKDC) examination form, Kellgren-Lawrence grade, graft maturation score on second-look arthroscopy, and revision rates at the last follow-up.

RESULTS

From an initial cohort of 171 consecutive patients over a 3-year period, 95 (56%) met inclusion and exclusion criteria. The SB ACLR+LET group (n = 47) showed significantly better results in pivot-shift grade at the last follow-up as compared with the DB ACLR group (n = 48) (P = .021). In the SB ACLR+LET group, 93.6% (44/47) were grade 0, whereas 72.9% (35/48) in the DB ACLR group were grade 0. The SB ACLR+LET group (grade A: 42, grade B: 4 and grade C: 1) showed significantly superior results in IKDC objective grade compared with the DB ACLR group (grade A: 32; grade B: 8; and grade C: 8) (P = .017). However, no statistically significant difference could be shown in anterior translation, subjective functional IKDC score, or revision rate between the 2 groups. The mean follow-up duration was 49.7 ± 5.7 months.

CONCLUSIONS

SB ACLR + LET demonstrated fewer pivot-shifts (P = .021) and superior IKDC objective grades (P = .017) than a DB ACLR at a mean follow-up of almost 50 months.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

目的

比较双束（DB）前交叉韧带重建（ACLR）与单束（SB）ACLR 联合外侧关节外束固定术（LET）术后客观膝关节稳定性和临床结果。

方法

纳入接受 DB ACLR（DB ACLR 组）或 SB ACLR 联合 LET（SB ACLR+LET 组）的 ACL 损伤患者，所有符合纳入和排除标准的患者均进行膝关节松弛度评估（前向平移和枢轴移位程度）、国际膝关节文献委员会（IKDC）检查、Kellgren-Lawrence 分级、二次关节镜检查的移植物成熟评分和末次随访时的翻修率。

结果

在 3 年的时间里，从最初的 171 例连续患者中，有 95 例（56%）符合纳入和排除标准。与 DB ACLR 组（n=48）相比，SB ACLR+LET 组（n=47）在末次随访时的枢轴移位程度明显更好（P=0.021）。在 SB ACLR+LET 组中，93.6%（44/47）为 0 级，而 DB ACLR 组为 72.9%（35/48）为 0 级。SB ACLR+LET 组（A级：42，B 级：4，C 级：1）的 IKDC 客观等级明显优于 DB ACLR 组（A级：32；B 级：8；C 级：8）（P=0.017）。然而，两组之间在前向平移、主观功能 IKDC 评分或翻修率方面没有显示出统计学上的显著差异。平均随访时间为 49.7±5.7 个月。