Yun Xing, Wei Yu, Li Zhongli, Liu Yujie, Wang Zhigang, Zhang Qiang, Liu Yang, Wei Min
Department of Orthopaedics, the First Medical Center of Chinese PLA General Hospital, Beijing, 100853, P.R.China.
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Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2021 Jan 15;35(1):58-63. doi: 10.7507/1002-1892.202008125.
To assess the mid-term effectiveness of anterior cruciate ligament (ACL) revision and to analyze the relevant factors that may affect the surgical outcomes.
The clinical data of 24 patients who underwent ACL revision surgery between April 2009 and July 2018 and were followed up for more than 2 years were retrospectively analyzed. There were 20 males and 4 females with a median age of 30 years [interquartile distance (IQR) was (25, 36) years]. The median body mass index was 24.45 kg/m and IQR was (22.93, 25.93) kg/m . The median time between ACL revision and reconstruction was 41 months and IQR was (15, 85) months. The direct cause of the failure of reconstruction surgery included 14 cases of trauma, 8 cases of no obvious cause, and 2 cases of infection. During the revision operation, 14 patients had a poor bone tunnel position, all of which were drilled with new tunnels, the remaining 10 patients were freshly modified on the basis of the original bone tunnel. Seventeen patients used autogenous tendon revision, 7 patients used LARS ligament; 16 patients had cartilage injury. The Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Tegner sports rating score were used for functional evaluation before operation, at 1 year after operation, and at last follow-up. The Likert satisfaction score was recorded at last follow-up.
Patients were followed up with a median time of 47 months and IQR was (32, 61) months. The Lysholm score, IKDC score, and Tegner sports rating score were significantly improved at 1 year after operation and at last follow-up when compared with preoperative scores ( <0.05). There was no significant difference between at last follow-up and at 1 year after operation ( >0.05). At last follow-up, the median Likert satisfaction score was 4.0 and IQR was (3.0, 4.5). According to the presence or absence of cartilage damage and the type of graft, the above scores at last follow-up were compared between the groups, and the differences were not significant ( >0.05). At last follow-up, 2 patients had graft fractures due to trauma again, and autogenous iliac bones were taken to fill the bone tunnel, and the second stage was revised; the rest of the patients recovered satisfactorily.
With preoperative identification of the cause of ACL reconstruction failure, the stability and function of knee joint can be significantly improved by selecting appropriate bone tunnels and grafts during the revision and by active rehabilitation exercises.
评估前交叉韧带（ACL）翻修术的中期疗效，并分析可能影响手术效果的相关因素。
回顾性分析2009年4月至2018年7月间接受ACL翻修手术且随访超过2年的24例患者的临床资料。其中男性20例，女性4例，年龄中位数为30岁[四分位数间距（IQR）为（25，36）岁]。体重指数中位数为24.45kg/m²，IQR为（22.93，25.93）kg/m²。ACL翻修与初次重建的时间间隔中位数为41个月，IQR为（15，85）个月。初次重建手术失败的直接原因包括外伤14例、无明显原因8例、感染2例。翻修手术中，14例患者骨隧道位置不佳，均重新钻孔，其余10例患者在原骨隧道基础上进行新鲜化处理。17例患者采用自体肌腱翻修，7例患者采用LARS韧带；16例患者存在软骨损伤。采用Lysholm评分、国际膝关节文献委员会（IKDC）评分及Tegner运动评级评分在术前、术后1年及末次随访时进行功能评估。末次随访时记录Likert满意度评分。
患者随访时间中位数为47个月，IQR为（32，61）个月。与术前评分相比，术后1年及末次随访时Lysholm评分、IKDC评分及Tegner运动评级评分均显著改善（P<0.05）。末次随访与术后1年相比差异无统计学意义（P>0.05）。末次随访时，Likert满意度评分中位数为4.0，IQR为（3.0，4.5）。根据软骨损伤情况及移植物类型，比较末次随访时各组上述评分，差异无统计学意义（P>0.05）。末次随访时，2例患者因外伤导致移植物断裂，取自体髂骨填充骨隧道，二期翻修；其余患者恢复满意。
术前明确ACL重建失败原因，翻修时选择合适的骨隧道及移植物，并积极进行康复锻炼，可显著改善膝关节的稳定性及功能。
