Feller Julian A, Devitt Brian M, Webster Kate E, Klemm Haydn J
OrthoSport Victoria Research Unit, Epworth HealthCare, Melbourne, Australia.
School of Allied Health, La Trobe University, Melbourne, Australia.
Orthop J Sports Med. 2021 Aug 13;9(8):23259671211021351. doi: 10.1177/23259671211021351. eCollection 2021 Aug.
Lateral extra-articular tenodesis (LET) has been used to augment primary anterior cruciate ligament (ACL) reconstruction to reduce the risk of reinjury. Most LET procedures result in a construct that is fixed to both the femur and the tibia. In a modified Ellison procedure, the construct is only fixed distally, reducing the risk of inadvertently overconstraining the lateral compartment.
To evaluate the use of the modified Ellison procedure in a cohort of patients deemed to be at a high risk of further ACL injury after primary ACL reconstruction.
Case series; Level of evidence, 4.
Included were 25 consecutive patients with at least 2 of the following risk factors: age <20 years at the time of surgery, previous contralateral ACL reconstruction, positive family history of ACL rupture (parent or sibling), generalized ligamentous laxity (Beighton ≥4), grade 3 pivot shift in the consulting room, a desire to return to a pivoting sport, and an elite or professional status. All patients underwent primary ACL reconstruction with an additional modified Ellison procedure. Postoperatively, patients completed the IKDC subjective knee evaluation form (International Knee Documentation Committee), KOOS Quality of Life subscale (Knee injury and Osteoarthritis Outcome Score), ACL-Return to Sport After Injury Scale, Marx Activity Rating Scale, and SANE score (Single Assessment Numeric Evaluation).
At 12-month follow-up, the mean outcome scores were as follows: SANE, 94/100; IKDC, 92/100; Marx, 13/16; ACL-Return to Sport, 85/100; and KOOS, 77/100. At 24 months, return-to-sport data were available for 23 of 25 patients; 17 (74%) were playing at the same level or higher than preinjury and 2 at a lower level. One patient (4%) sustained a contact mechanism graft rupture at 12 months. There were 2 (9%) contralateral ACL injuries, including 1 ACL graft rupture, at 11 and 22 months postoperatively. There was a further contralateral ACL graft rupture at 26 months.
The use of the modified Ellison procedure as a LET augmentation of a primary ACL reconstruction to produce a low graft rupture rate appeared to be safe in a cohort considered to be at a high risk of reinjury. The procedure showed promise in terms of reducing further graft injuries.
外侧关节外肌腱固定术（LET）已被用于加强初次前交叉韧带（ACL）重建，以降低再次受伤的风险。大多数LET手术会形成一个固定在股骨和胫骨上的结构。在改良的埃里森手术中，该结构仅在远端固定，降低了无意中过度限制外侧间室的风险。
评估改良埃里森手术在一组初次ACL重建后被认为有较高再次ACL损伤风险的患者中的应用。
病例系列；证据等级，4级。
纳入25例连续患者，这些患者至少具备以下风险因素中的2项：手术时年龄<20岁、既往对侧ACL重建、ACL破裂的阳性家族史（父母或兄弟姐妹）、全身性韧带松弛（Beighton评分≥4）、诊室中3级轴移、希望恢复旋转运动以及精英或职业身份。所有患者均接受了初次ACL重建及额外的改良埃里森手术。术后，患者完成IKDC主观膝关节评估表（国际膝关节文献委员会）、KOOS生活质量子量表（膝关节损伤和骨关节炎结局评分）、ACL损伤后恢复运动量表、马克思活动评分量表和SANE评分（单项评估数字评价）。
在12个月的随访中，平均结局评分如下：SANE为94/100；IKDC为92/100；马克思评分为13/16；ACL恢复运动评分为85/100；KOOS为77/100。在24个月时，25例患者中有23例有恢复运动的数据；17例（74%）的运动水平与受伤前相同或更高，2例运动水平较低。1例患者（4%）在12个月时因接触机制导致移植物破裂。术后11个月和22个月有2例（9%）对侧ACL损伤，其中1例为ACL移植物破裂。在26个月时又有1例对侧ACL移植物破裂。
在一组被认为有较高再次受伤风险的患者中，使用改良埃里森手术作为LET加强初次ACL重建以产生较低的移植物破裂率似乎是安全的。该手术在减少进一步的移植物损伤方面显示出前景。
