Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.
Arizona Brain, Spine and Sports Injuries Center, Scottsdale, Arizona, USA.
Am J Sports Med. 2021 May;49(6):1431-1440. doi: 10.1177/0363546521996389. Epub 2021 Mar 10.
Preoperative tunnel widening is a frequently reported indication for performing a 2-stage revision anterior cruciate ligament reconstruction (ACLR) instead of a single-stage procedure. However, the strength of the available evidence to support a 2-stage strategy is low.
PURPOSE/HYPOTHESIS: The purpose was to evaluate the clinical outcomes of a single stage-only approach to revision ACLR. It was hypothesized that this approach would be associated with significant improvements from baseline in patient-reported outcome measures (PROMs) and knee stability and that there would be no significant differences in any postoperative outcomes between patients with and without preoperative tunnel widening.
Cohort study; Level of evidence, 3.
A retrospective analysis was conducted of a large series of consecutive patients undergoing revision ACLR with a minimum follow-up of 2 years. Preoperative tunnel widening was assessed using digital radiographs. All patients underwent single-stage surgery with an outside-in technique, regardless of the degree of tunnel widening. Clinical outcomes were compared according to whether tunnel widening was present (either tunnel ≥12 mm) or not (both tunnels <12 mm).
The study included 409 patients with a mean ± SD follow-up of 69.6 ± 29.0 months. After revision ACLR, there was a significant reduction in the side-to-side anteroposterior laxity difference, from 7.7 ± 2.2 mm preoperatively to 1.2 ± 1.1 mm at 2 years ( < .001). The mean International Knee Documentation Committee (IKDC) and all subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) exceeded the thresholds for the Patient Acceptable Symptom State defined for primary ACLR. An overall 358 patients had retrievable preoperative radiographs. According to the tunnel diameter measurements, 111 patients were allocated to group A (both tunnels <12 mm) and 247 patients to group B (either/both tunnels ≥12 mm). There were no significant differences between groups with respect to anteroposterior side-to-side laxity difference, graft rupture rates, non-graft rupture related reoperations, or contralateral anterior cruciate ligament injury rates. There was also no significant difference between groups that exceeded minimal detectable change thresholds for any of the PROMs recorded (ACL-RSI [Anterior Cruciate Ligament-Return to Sports After Injury], Lysholm, Tegner, IKDC, KOOS).
A single-stage approach to revision ACLR is associated with excellent clinical results when an outside-in drilling technique is utilized. The presence of preoperative tunnel widening does not significantly influence PROMs, knee stability, graft rupture rates, or non-graft rupture related reoperation rates.
术前隧道增宽是行 2 期翻修前交叉韧带重建术（ACLR）而非单期手术的常见指征。然而，支持 2 期策略的证据强度较低。
目的/假设：本研究旨在评估单期翻修 ACLR 方法的临床效果。假设该方法与患者报告的结果测量（PROM）和膝关节稳定性从基线显著改善相关，且隧道增宽患者与无隧道增宽患者在任何术后结果方面无显著差异。
队列研究；证据水平，3 级。
对接受单期翻修 ACLR 且随访至少 2 年的大量连续患者进行回顾性分析。使用数字 X 线片评估术前隧道增宽。所有患者均采用经皮外入路技术行单期手术，无论隧道增宽程度如何。根据是否存在隧道增宽（隧道≥12mm）或无隧道增宽（双侧隧道＜12mm）来比较临床结果。
该研究纳入了 409 例患者，平均随访 69.6±29.0 个月。翻修 ACLR 后，侧方前后向松弛度差值从术前的 7.7±2.2mm显著降低至 2 年时的 1.2±1.1mm（＜0.001）。国际膝关节文献委员会（IKDC）和膝关节损伤和骨关节炎结果评分（KOOS）的所有亚量表的平均水平均超过了原发性 ACLR 定义的可接受症状状态的阈值。共有 358 例患者可获得可检索的术前 X 线片。根据隧道直径测量结果，111 例患者被分配至 A 组（双侧隧道＜12mm），247 例患者被分配至 B 组（单侧/双侧隧道≥12mm）。两组间在侧方前后向松弛度差值、移植物断裂率、非移植物断裂相关再手术率或对侧前交叉韧带损伤率方面无显著差异。在记录的任何 PROM 中，两组均未达到最小可检测变化阈值（ACL-RSI[损伤后重返运动的前交叉韧带]、Lysholm、Tegner、IKDC、KOOS），这两组之间也无显著差异。
当采用经皮外入路钻孔技术时，单期翻修 ACLR 与良好的临床效果相关。术前隧道增宽并不显著影响 PROM、膝关节稳定性、移植物断裂率或非移植物断裂相关再手术率。
