Park Clinic Orthopaedics, Melbourne Knee Centre, Kew, Australia.
Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA.
Am J Sports Med. 2021 Feb;49(2):364-373. doi: 10.1177/0363546520976633. Epub 2020 Dec 17.
The increased prevalence of anterior cruciate ligament (ACL) reconstruction has led to an increased need for revision ACL reconstructions. Despite the growing body of literature indicating that single-stage revision ACL reconstruction can yield good outcomes, there is a lack of data for determining when and how to safely perform a single-stage revision.
To assess the outcomes, graft failure rates, and return-to-play rates of a decision-making algorithm for single-stage revision ACL reconstruction.
Case series; Level of evidence, 4.
We reviewed a consecutive series of revision ACL reconstructions performed by the senior author between September 2009 and July 2016 with minimum 2-year follow-up. All patients were assessed, and decision making was undertaken according to the algorithm. Outcomes measured were further surgery, graft rerupture, re-revision, Tegner score, and Knee injury and Osteoarthritis Outcome Score (KOOS). For the elite athlete population, return-to-play time, duration, and level of play after surgery as compared with preinjury were also determined.
During this period, 93 procedures were performed in 92 patients (40 elite athletes). Two 2-stage procedures were undertaken, leaving 91 single-stage procedures (91 patients) to form the basis for further study. At a mean 4.3 years (SD, 2.2 years) after surgery, there had been 2 re-revisions (2.2%) and 2 further instances of graft failure that had not been re-revised (total graft failure rate, 4.4%). There were 17 subsequent procedures, including 6 arthroscopic partial meniscectomies, 5 removals of prominent implants, and 1 total knee arthroplasty. The mean Tegner score was 8.02 before graft rerupture and 7.1 at follow-up. At follow-up, the mean KOOS outcomes were 79.3 for Symptoms, 88.0 for Pain, 94.2 for Activities of Daily Living, 73.6 for Sport, and 68.9 for Quality of Life. Of 40 elite athletes, 35 returned to play at a mean 11.2 months (SD, 3.6 months) after surgery.
Single-stage revision ACL reconstructions can be performed reliably in the majority of patients, with good clinical outcomes, low rerupture rates, and high-return-to play rates, even in the elite athlete population.
前交叉韧带（ACL）重建的患病率增加，导致需要进行更多的 ACL 翻修手术。尽管越来越多的文献表明，单阶段翻修 ACL 重建可以获得良好的结果，但对于何时以及如何安全地进行单阶段翻修，仍缺乏数据。
评估单阶段翻修 ACL 重建决策算法的结果、移植物失败率和重返赛场率。
病例系列；证据水平，4 级。
我们回顾了 2009 年 9 月至 2016 年 7 月期间由资深作者进行的连续系列 ACL 翻修手术，所有患者均接受了至少 2 年的随访。所有患者均接受评估，并根据算法做出决策。测量的结果包括进一步手术、移植物再断裂、再翻修、Tegner 评分和膝关节损伤和骨关节炎评分（KOOS）。对于精英运动员群体，还确定了手术后重返赛场的时间、持续时间和比赛级别与受伤前相比的情况。
在此期间，92 名患者（40 名精英运动员）进行了 93 次手术。2 次进行了 2 阶段手术，其余 91 次单阶段手术（91 名患者）作为进一步研究的基础。手术后平均 4.3 年（标准差，2.2 年），有 2 次再翻修（2.2%）和 2 次未再翻修的移植物失败（总移植物失败率，4.4%）。共有 17 次后续手术，包括 6 次关节镜下半月板部分切除术、5 次取出突出的植入物和 1 次全膝关节置换术。移植物再断裂前的平均 Tegner 评分为 8.02，随访时为 7.1。随访时，KOOS 结果的平均症状评分为 79.3，疼痛评分为 88.0，日常生活活动评分为 94.2，运动评分为 73.6，生活质量评分为 68.9。40 名精英运动员中，有 35 名在手术后平均 11.2 个月（标准差，3.6 个月）后重返赛场。
单阶段翻修 ACL 重建术在大多数患者中可可靠进行，具有良好的临床结果、低再断裂率和高重返赛场率，即使在精英运动员群体中也是如此。
