Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States; Spaarne Gasthuis Hospital, Department of Orthopaedic Surgery, Hoofddorp, the Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Department of Orthopaedic Surgery, Amsterdam, the Netherlands.
Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, United States.
Knee. 2021 Mar;29:142-149. doi: 10.1016/j.knee.2021.01.028. Epub 2021 Feb 21.
To assess whether primary repair of proximal ACL tears in the delayed setting leads to similar clinical and functional outcomes as compared to ACL repair in the acute setting.
All patients with proximal tears with good tissue quality treated in the acute (≤3 weeks post-injury) and delayed setting (>3 months post-injury) were retrospectively reviewed at minimum 2-year follow-up. Ipsilateral reinjury or reoperation and contralateral injury rates were recorded. Functional outcomes were evaluated using the Lysholm, modified Cincinnati, Single Assessment Numeric Evaluation, International Knee Documentation Committee subjective, Forgotten Joint Score-12, Anterior Cruciate Ligament-Return to Sport after Injury scale, and satisfaction scores. Finally, time to return to work, time to discontinue brace-usage, time to running, and time to return to sports were reviewed. Group differences were compared using chi-square tests and Mann-Whitney U tests.
Sixty-nine patients were included, of which 34 (49%) were treated acutely and 35 (51%) in the delayed setting. Besides time from injury to surgery, patient demographics were similar between groups (all p > 0.1). There were three reinjuries (9%) in the acute group and four in the delayed (11%; p > 0.999). Reoperation, complication, and contralateral injury rates were similar between groups (all p > 0.1), while functional outcomes were also comparable (all p > 0.05).
This study found that acute and delayed primary ACL repair results in similar clinical and functional outcomes at short to mid-term follow-up. Therefore, the most important factors for repair surgery success seem to be tissue quality and tissue length, rather than acuity of the surgery.
Level III, retrospective comparative cohort study.
评估延迟情况下初次修复 ACL 近端撕裂与急性情况下修复 ACL 相比是否具有相似的临床和功能结果。
对至少 2 年随访的具有良好组织质量的 ACL 近端撕裂且处于急性（<3 周）和延迟（>3 个月）期的所有患者进行回顾性分析。记录同侧再损伤或再手术率和对侧损伤率。使用 Lysholm、改良 Cincinnati、单项评估数值评估、国际膝关节文献委员会主观评分、遗忘关节评分-12、前交叉韧带损伤后重返运动评分和满意度评分评估功能结果。最后，回顾重返工作时间、停止使用支具时间、开始跑步时间和重返运动时间。使用卡方检验和曼-惠特尼 U 检验比较组间差异。
共纳入 69 例患者，其中 34 例（49%）接受急性治疗，35 例（51%）接受延迟治疗。除受伤至手术的时间外，两组患者的人口统计学特征相似（均 p>0.1）。急性组有 3 例再损伤（9%），延迟组有 4 例（11%；p>0.999）。两组的再手术率、并发症率和对侧损伤率相似（均 p>0.1），功能结果也相似（均 p>0.05）。
本研究发现，急性和延迟初次 ACL 修复在短期至中期随访中可获得相似的临床和功能结果。因此，修复手术成功的最重要因素似乎是组织质量和组织长度，而不是手术的及时性。
III 级，回顾性比较队列研究。
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