Department of Prosthetic Dentistry, Sechenov First Moscow State Medical University (Sechenov University), Moscow.
Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan.
Acta Orthop. 2021 Aug;92(4):443-447. doi: 10.1080/17453674.2021.1897744. Epub 2021 Mar 19.
Background and purpose - The frequency of primary anterior cruciate ligament (ACL) reconstruction is increasing resulting in more ACL revision surgeries. Therefore, we assessed survival rates of 2 different grafts for ACL revision surgery at 1- and 5-year follow-ups, as well as physical activity levels of patients after revision surgery.Patients and methods - This is a retrospective cohort study involving 218 patients (176 males) who had revision surgery for anterior cruciate ligament injuries between 2008 and 2017 at the Clinic of Traumatology, Orthopedics and Joint Pathology Clinic (I.M. Sechenov First Moscow State Medical University). A comparison group involved 189 patients with only primary surgery. Surgical interventions were performed according to the standard procedure using bone-patellar tendon-bone (BTB) and semitendinosus/gracilis (ST/G) autografts. The results of revision surgery were assessed at 1- and 5-year follow-ups by using the Lysholm and International Knee Documentation Committee scores.Results - Malpositioned bone tunnels were found in 87/218 patients (40%). At 1 and 5 years postoperatively, the revision BTB group had significantly better results in terms of IKDC and Lysholm scores than the revision ST/G group (p = 0.03, Mann-Whitney U-test), and these results were comparable to those in the comparison group. Graft survival after revision was lower than after the primary operation. However, the survival rate of 80% is quite high and is consistent with previous findings. There were no statistically reliable differences in survival between ST/G and BTB autografts.Interpretation - The graft choice for revision ACL surgery should be decided upon before surgery based on, among other things, the state of bone tunnels, in particular their position and degree of bone resorption. Tunnel widening that exceeds 14 mm (osteolysis) would require 2-stage surgery using a BTB autograft with bone plugs because it is larger than the ST/G autograft.
初次前交叉韧带（ACL）重建的频率正在增加，导致更多的 ACL 翻修手术。因此，我们评估了两种不同移植物进行 ACL 翻修手术的 1 年和 5 年随访时的生存率，以及翻修手术后患者的身体活动水平。
这是一项回顾性队列研究，纳入了 2008 年至 2017 年在创伤科、矫形科和关节病理科诊所（I.M. Sechenov 第一莫斯科国立医科大学）接受 ACL 损伤翻修手术的 218 例（176 例男性）患者。对照组包括仅接受初次手术的 189 例患者。手术干预根据标准程序进行，使用骨-髌腱-骨（BTB）和半腱肌/股薄肌（ST/G）自体移植物。使用 Lysholm 和国际膝关节文献委员会评分在 1 年和 5 年随访时评估翻修手术的结果。
在 218 例患者中有 87 例（40%）发现骨隧道位置不当。在术后 1 年和 5 年时，翻修 BTB 组的 IKDC 和 Lysholm 评分明显优于翻修 ST/G 组（p=0.03，Mann-Whitney U 检验），且与对照组相比这些结果相当。翻修后的移植物存活率低于初次手术。然而，80%的存活率相当高，与之前的发现一致。ST/G 和 BTB 自体移植物之间的存活率没有统计学上的显著差异。
ACL 翻修手术的移植物选择应根据骨隧道的状态，特别是其位置和骨吸收程度，在手术前决定。如果隧道增宽超过 14mm（骨溶解），则需要使用 BTB 自体移植物和骨塞进行 2 期手术，因为它比 ST/G 自体移植物大。
