Jiang Y F, Wang J, Wang Y J, Liu J, Pei Y, Liu X P, Ao Y F, Ma Y
Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2021 Oct 18;53(5):857-864. doi: 10.19723/j.issn.1671-167X.2021.05.008.
To assess the mid-to-long term clinical outcomes after anterior cruciate ligament (ACL) revision surgery and to analyze their predictors.
The medical records of 235 patients undergoing ACL revision surgery between Jan. 2001 and Dec. 2015 at Department of Sports Medicine, Peking University Third Hospital were reviewed. Data were collected including demographic information, information related to revision surgery (time and cause of graft failure, date of revision surgery, surgical technique, combined injuries and management, .), as well as information related to primary ACL reconstruction (time, cause and mechanism of first-time ACL rupture, date of primary ACL reconstruction, surgical technique, combined injuries and management, .). Patients were followed up at least 2 years after revision surgery for clinical outcomes [Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) subjective knee score]. Post-revision surgeries on the involved knee and the contralateral knee joint were also documented. Multivariate regression model was used to analyze the predictors of clinical outcomes after ACL revision surgery.
A total of 166 (70.63%) patients were followed up at a mean of (4.44±2.40) years (2.03-14.63 years). Clinical outcomes improved significantly at the last follow-up from pre-operative level, with the Lysholm, Tegner, and IKDC scores improving from 70.51±21.25, 3.39±1.77, 63.78±15.04 to 88.64±14.36, 4.67±1.739, 80.23±13.31 ( < 0.05), respectively. Three (1.81%) patients experienced infection while 39 (23.49%) patients underwent surgery after revision surgery during the follow-up. Compared with that those occurred during sports, graft failure that occurred during daily activities or due to surgical technical errors that led to poorer clinical outcomes, with the Lysholm, Tegner, and IKDC scores of 9.90 (95%: 1.49-18.31), 1.41 (95%: 0.10-2.72), 10.35 (95%: 0.17-20.54), and 8.53 (95%: 1.31-15.75), 1.28 (95%: 0.14-2.43), 9.39 (95%: 1.03-17.74) lower, respectively. Compared with antero-medial portal, transtibial technique for placement of the femoral bone tunnel showed poorer Lysholm scores of 11.18 (95%: 4.73-17.63, =0.001). Concurrent repair of medial meniscus yielded higher IKDC scores of 11.06 (95%: 1.21-20.92, =0.029) than those with intact medical meniscus. Other factors showed no significant effect.
ACL revision surgery is able to restore knee stability and improve knee function. Graft failure caused by sports, concurrent repair of medical meniscus and antero-medial portal technique predicts better outcomes after revision surgery.
评估前交叉韧带（ACL）翻修术后的中长期临床疗效，并分析其预测因素。
回顾性分析2001年1月至2015年12月在北京大学第三医院运动医学科接受ACL翻修手术的235例患者的病历资料。收集的数据包括人口统计学信息、与翻修手术相关的信息（移植物失败的时间和原因、翻修手术日期、手术技术、合并损伤及处理等），以及与初次ACL重建相关的信息（首次ACL断裂的时间、原因和机制、初次ACL重建日期、手术技术、合并损伤及处理等）。患者在翻修手术后至少随访2年以评估临床疗效[Tegner评分、Lysholm评分和国际膝关节文献委员会（IKDC）主观膝关节评分]。记录患侧膝关节及对侧膝关节翻修术后的手术情况。采用多因素回归模型分析ACL翻修术后临床疗效的预测因素。
共166例（70.63%）患者获得随访，平均随访时间为（4.44±2.40）年（2.03 - 14.63年）。末次随访时临床疗效较术前显著改善，Lysholm、Tegner和IKDC评分分别从70.51±21.25、3.39±1.77、63.78±15.04提高至88.64±14.36、4.67±1.739、80.23±13.31（均P<0.05）。随访期间3例（1.81%）患者发生感染，39例（23.49%）患者接受了翻修术后手术。与运动中发生的移植物失败相比，日常活动中发生的移植物失败或因手术技术失误导致的临床疗效较差，Lysholm、Tegner和IKDC评分分别低9.90（95%CI：1.49 - 18.31）、1.41（95%CI：0.10 - 2.72）、10.35（95%CI：0.17 - 20.54）以及8.53（95%CI：1.31 - 15.75）、1.28（95%CI：0.14 - 2.43）、9.39（95%CI：1.03 - 17.7）。与前内侧入路相比，经胫骨技术放置股骨骨隧道的Lysholm评分较低，为11.18（95%CI：4.73 - 17.63，P = 0.001）。同时修复内侧半月板的IKDC评分高于内侧半月板完整者，为11.06（95%CI：1.21 - 20.92，P = 0.029）。其他因素无显著影响。
ACL翻修手术能够恢复膝关节稳定性并改善膝关节功能。运动导致的移植物失败、同时修复内侧半月板以及采用前内侧入路技术可预测翻修术后更好的疗效。
