Alm Lena, Drenck Tobias Claus, Frings Jannik, Krause Matthias, Korthaus Alexander, Krukenberg Anna, Frosch Karl-Heinz, Akoto Ralph
Department of Trauma and Orthopaedic Surgery, Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany.
Asklepios Clinic St Georg, Hamburg, Germany.
Orthop J Sports Med. 2021 Mar 15;9(3):2325967121989312. doi: 10.1177/2325967121989312. eCollection 2021 Mar.
Concomitant lesion of the medial collateral ligament (MCL) is associated with a greater risk of anterior cruciate ligament (ACL) graft failure.
The aim of this study was to compare two medial stabilization techniques in patients with revision ACL reconstruction (ACLR) and concomitant chronic medial knee instability.
Cohort study; Level of evidence, 3.
In a retrospective study, we included 53 patients with revision ACLR and chronic grade 2 medial knee instability to compare medial surgical techniques (MCL reconstruction [n = 17] vs repair [n = 36]). Postoperative failure of the revision ACLR (primary aim) was defined as side-to-side difference in Rolimeter testing ≥5 mm or pivot-shift grade ≥2. Clinical parameters and postoperative functional scores (secondary aim) were evaluated with a mean ± SD follow-up of 28.8 ± 9 months (range, 24-69 months).
Revision ACLR was performed in 53 patients with additional grade 2 medial instability (men, n = 33; women, n = 20; mean age, 31.3 ± 12 years). Failure occurred in 5.9% (n = 1) in the MCL reconstruction group, whereas 36.1% (n = 13) of patients with MCL repair showed a failed revision ACLR ( = .02). In the postoperative assessment, the anterior side-to-side difference in Rolimeter testing was significantly reduced (1.5 ± 1.9 mm vs 2.9 ± 2.3 mm; = .037), and medial knee instability occurred significantly less (18% vs 50%; = .025) in the MCL reconstruction group than in the MCL repair group. In the logistic regression, patients showed a 9-times elevated risk of failure when an MCL repair was performed ( = .043). Patient-reported outcomes were increased in the MCL reconstruction group as compared with MCL repair, but only the Lysholm score showed a significant difference (Tegner, 5.6 ± 1.9 vs 5.3 ± 1.6; International Knee Documentation Committee, 80.3 ± 16.6 vs 73.6 ± 16.4; Lysholm, 82.9 ± 13.6 vs 75.1 ± 21.1 [ = .047]).
MCL reconstruction led to lower failure rates in patients with combined revision ACLR and chronic medial instability as compared with MCL repair. MCL reconstruction was superior to MCL repair, as lower postoperative anterior instability, an increased Lysholm score, and less medial instability were present after revision ACLR. MCL repair was associated with a 9-times greater risk of failure.
内侧副韧带（MCL）合并损伤与前交叉韧带（ACL）移植物失败风险增加相关。
本研究旨在比较两种内侧稳定技术在翻修前交叉韧带重建术（ACLR）合并慢性膝关节内侧不稳患者中的应用效果。
队列研究；证据等级，3级。
在一项回顾性研究中，我们纳入了53例翻修ACLR合并慢性2级膝关节内侧不稳的患者，比较内侧手术技术（MCL重建[n = 17]与修复[n = 36]）。翻修ACLR术后失败（主要目标）定义为Rolimeter测试双侧差异≥5 mm或轴移分级≥2级。临床参数和术后功能评分（次要目标）在平均±标准差为28.8±9个月（范围，24 - 69个月）的随访中进行评估。
53例患者接受了翻修ACLR，同时伴有2级内侧不稳（男性，n = 33；女性，n = 20；平均年龄，31.3±12岁）。MCL重建组失败率为5.9%（n = 1），而MCL修复组36.1%（n = 13）的患者翻修ACLR失败（P = 0.02）。在术后评估中，MCL重建组Rolimeter测试前后侧差异显著降低（1.5±1.9 mm对2.9±2.3 mm；P = 0.037），膝关节内侧不稳发生率显著降低（18%对50%；P = 0.025）。在逻辑回归分析中，进行MCL修复的患者失败风险增加9倍（P = 0.043）。与MCL修复组相比，MCL重建组患者报告的结局有所改善，但只有Lysholm评分显示出显著差异（Tegner评分，5.6±1.9对5.3±1.6；国际膝关节文献委员会评分，80.3±16.6对73.6±16.4；Lysholm评分，82.9±13.6对75.1±21.1[P = 0.047]）。
与MCL修复相比，MCL重建在翻修ACLR合并慢性内侧不稳患者中导致更低的失败率。MCL重建优于MCL修复，因为翻修ACLR术后前侧不稳更低、Lysholm评分增加且内侧不稳更少。MCL修复与9倍的更高失败风险相关。
