Asahi University Hospital, Gifu, Japan.
Department of Orthopaedic Surgery, Asahi University Hospital, 3-23 Hashimotocho, Gifu, 500-8523, Japan.
Arch Orthop Trauma Surg. 2021 Jun;141(6):971-975. doi: 10.1007/s00402-020-03745-4. Epub 2021 Jan 11.
No widely accepted evidence-based indications exist for the initial surgical management of patients with anterior cruciate ligament (ACL) injuries ≥ 40 years old, and treatment for these patients remains controversial. This study aimed to evaluate the association between elapsed time from ACL injury to surgery and the incidence of meniscal tears and chondral injury in patients aged ≥ 40 years.
The patients who underwent primary ACL reconstruction were divided into two groups based on elapsed time from injury to surgery: early group, < 12 months; and delayed group, ≥ 12 months. Patient records were reviewed for incidence and types of meniscal tears and chondral injuries in each group. Chondral injury grades were evaluated with International Cartilage Regeneration and Joint Preservation Society (ICRS) Criteria.
This study evaluated 67 knees in the early group and 33 knees in the delayed group. Mean ages in each group were 46.9 ± 6.5 and 46.9 ± 6.0. The delayed group showed significantly higher rates of medial meniscal tear [31 of 33, 93.9% vs 29 of 67, 43.3%; P < 0.0001; odds ratio (OR), 20.31; 95% confidence interval (CI), 4.49-91.9], medial femoral condyle chondral injuries ≥ ICRS grade II (15 of 33, 45.5% vs 8 of 67, 11.9%; P < 0.001; OR, 6.15; 95% CI 2.24-16.83), and medial tibial chondral injuries ≥ ICRS grade II (7 of 33, 21.2% vs 3 of 67, 4.5%; P < 0.05; OR, 5.74; 95% CI 1.38-23.9) compared with the early group. With respect to types of medial meniscal tear, the delayed group showed a significantly higher frequency of bucket handle tears (11 of 33, 33.3%) compared with the early group (2 of 67, 3.0%; P < 0.0001; OR, 16.25; 95% CI 3.34-79.1).
Delayed ACL reconstruction was associated with increased incidence of chondral injuries and medial meniscal tears, particularly bucket handle tears in this cohort.
Level III.
对于年龄≥40 岁的前交叉韧带（ACL）损伤患者，目前尚无广泛认可的循证医学适应证来指导初始手术治疗，因此对这些患者的治疗仍存在争议。本研究旨在评估 ACL 损伤至手术的时间间隔与≥40 岁患者半月板撕裂和软骨损伤发生率之间的相关性。
根据 ACL 损伤至手术的时间间隔，将接受初次 ACL 重建的患者分为两组：早期组，<12 个月；延迟组，≥12 个月。评估每组患者的半月板撕裂和软骨损伤的发生率和类型。软骨损伤分级采用国际软骨修复和关节保存协会（ICRS）标准进行评估。
本研究共纳入 67 例早期组和 33 例延迟组患者。两组的平均年龄分别为 46.9±6.5 岁和 46.9±6.0 岁。延迟组的内侧半月板撕裂发生率明显更高[33 例中的 31 例（93.9%）比 67 例中的 29 例（43.3%）；P<0.0001；比值比（OR）为 20.31；95%置信区间（CI）为 4.49-91.9]，内侧股骨髁软骨损伤≥ICRS 分级 II （33 例中的 15 例（45.5%）比 67 例中的 8 例（11.9%）；P<0.001；OR 为 6.15；95%CI 为 2.24-16.83），以及内侧胫骨软骨损伤≥ICRS 分级 II （33 例中的 7 例（21.2%）比 67 例中的 3 例（4.5%）；P<0.05；OR 为 5.74；95%CI 为 1.38-23.9），与早期组相比。就内侧半月板撕裂的类型而言，延迟组的桶柄状撕裂发生率明显高于早期组（33 例中的 11 例（33.3%）比 67 例中的 2 例（3.0%）；P<0.0001；OR 为 16.25；95%CI 为 3.34-79.1）。
在本队列中，ACL 延迟重建与软骨损伤和内侧半月板撕裂发生率增加相关，特别是桶柄状撕裂。
III 级。
