Marom Niv, Kleeblad Laura J, Ling Daphne, Nwachukwu Benedict U, Marx Robert G, Potter Hollis G, Pearle Andrew D
Hospital for Special Surgery, 535 E. 70th St., New York, NY 10021 USA.
HSS J. 2020 Dec;16(Suppl 2):475-481. doi: 10.1007/s11420-019-09724-9. Epub 2019 Oct 17.
It has been suggested that the degree of anterior tibial translation (ATT) as measured passively on imaging studies (static ATT) after an anterior cruciate ligament (ACL) injury may influence outcomes after ACL reconstruction. However, there is a lack of evidence supporting these suggestions.
QUESTIONS/PURPOSES: The purpose of this retrospective prognostic study was to assess the predictive value of pre-operative static ATT in knees with ACL injury on return to sport and in satisfaction after ACL reconstruction. Our hypothesis was that greater static ATT would be associated with lower rates of return to sport and lower levels of satisfaction.
Patients treated with ACL reconstruction were identified from an institutional registry and assigned to one of three groups according to their ACL injury type: acute ACL injury, chronic ACL injury, and failed ACL reconstruction. ATT in each knee compartment was measured using magnetic resonance imaging, and a retrospective telephone questionnaire was used to investigate post-ACL reconstruction return to sport and subjects' satisfaction.
One hundred thirty patients (52 acute with ACL injury, 29 with chronic ACL injury, and 49 with failed ACL reconstruction) completed the questionnaire, with a mean follow-up of 5.67 years. Ninety-seven patients (74.6%) returned to their primary sport, of whom 63 (65%) returned to the same level of sport. The mean time to return to sport was 10.1 months (range, 2 to 24 months). Overall, 113 patients (87%) were either very satisfied or satisfied with their outcomes. No difference in medial or lateral ATT was found between patients who returned to sport and those who did not. The failed-ACL reconstruction group had significantly lower rates of return to sport than did acutely and chronically injured patients (60.4% versus 88.5% and 75.9%, respectively).
The degree of pre-operative ATT in an ACL-deficient knee was not correlated with return to sport or satisfaction after ACL reconstruction. In this study cohort, only failed-ACL reconstruction patients undergoing revision ACL reconstruction were significantly less likely to return to their main sport. They were also less likely to return to sport at their pre-operative level, if they did return to sport.
有人提出，前交叉韧带（ACL）损伤后影像学检查被动测量的胫骨前移程度（ATT）（静态ATT）可能会影响ACL重建后的结果。然而，缺乏支持这些观点的证据。
问题/目的：这项回顾性预后研究的目的是评估术前静态ATT对ACL损伤膝关节恢复运动及ACL重建后满意度的预测价值。我们的假设是，更大的静态ATT与更低的恢复运动率和更低的满意度相关。
从机构登记处确定接受ACL重建治疗的患者，并根据其ACL损伤类型分为三组：急性ACL损伤、慢性ACL损伤和ACL重建失败。使用磁共振成像测量每个膝关节腔的ATT，并通过回顾性电话问卷调查ACL重建后恢复运动情况和患者满意度。
130例患者（52例急性ACL损伤、29例慢性ACL损伤、49例ACL重建失败）完成问卷，平均随访5.67年。97例患者（74.6%）恢复了主要运动，其中63例（65%）恢复到相同运动水平。恢复运动的平均时间为10.1个月（范围2至24个月）。总体而言，113例患者（87%）对其结果非常满意或满意。恢复运动的患者与未恢复运动的患者在内侧或外侧ATT方面未发现差异。ACL重建失败组恢复运动的比例明显低于急性和慢性损伤患者（分别为60.4%、88.5%和75.9%）。
ACL缺失膝关节的术前ATT程度与ACL重建后恢复运动或满意度无关。在本研究队列中，只有接受翻修ACL重建的ACL重建失败患者恢复主要运动的可能性显著降低。如果他们确实恢复了运动，恢复到术前运动水平的可能性也较小。
