关节镜确认股骨纽扣的部署可防止 ACL 重建中的软组织嵌顿。
Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition in ACL reconstruction.
机构信息
Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 Jul;30(7):2251-2258. doi: 10.1007/s00167-021-06758-7. Epub 2021 Oct 19.
PURPOSE
The purpose of this study was to determine whether direct arthroscopic control of femoral buttons can prevent improper deployment and soft tissue interposition in anterior cruciate ligament (ACL) reconstruction.
METHODS
A retrospective analysis of prospectively collected data from the SANTI study group database was performed. All patients who underwent ACL reconstruction using suspensive femoral fixation between 01/01/2017 and 31/12/2019 were included. Patient assessment included demographics, sports metrics, reoperations performed and femoral button-related specific complications such as iliotibial band (ITB) irritation and/or septic arthritis. Proper deployment of the button and soft tissue interposition were assessed on postoperative radiographs.
RESULTS
A total of 307 patients underwent ACL reconstruction using adjustable femoral button fixation and were analyzed after a mean follow-up of 35.2 ± 11.0 months (14.3-50.2). The mean age was 39.5 ± 10.9-years old (range 13.3-70.6). Postoperative radiographs showed a correctly deployed femoral button without soft tissue interposition for all patients. No septic arthritis was reported. Nine patients (2.9%) suffered from lateral pain related to ITB irritation due to the button. Five of them had their symptoms resolve during rehabilitation. Ultrasound-guided corticosteroid infiltration was necessary for four patients after an average delay of 14.5 ± 4.8 months (11.7-21.7). Three patients were then symptom-free, but one required surgical removal of the implant 27.5 months after the surgery. Regarding unrelated femoral button complications, 15 patients (4.9%) underwent secondary arthroscopic procedures, including meniscectomy (1.6%), surgery for cyclops syndrome (2.6%) and revision ACLR (0.7%).
CONCLUSION
Arthroscopic confirmation of femoral button deployment prevents soft tissue interposition without specific complications.
LEVEL OF EVIDENCE
Level IV.
目的
本研究旨在确定直接关节镜控制股骨纽扣是否可以防止前交叉韧带（ACL）重建中纽扣不当部署和软组织嵌顿。
方法
对 SANTI 研究组数据库中前瞻性收集的数据进行回顾性分析。纳入 2017 年 1 月 1 日至 2019 年 12 月 31 日期间使用悬吊式股骨固定进行 ACL 重建的所有患者。患者评估包括人口统计学、运动学指标、再次手术以及与股骨纽扣相关的特定并发症，如髂胫束（ITB）刺激和/或化脓性关节炎。术后 X 线片评估纽扣的正确部署和软组织嵌顿情况。
结果
共有 307 例患者接受了可调式股骨纽扣固定的 ACL 重建，平均随访 35.2±11.0 个月（14.3-50.2）后进行分析。平均年龄为 39.5±10.9 岁（范围 13.3-70.6）。所有患者术后 X 线片均显示股骨纽扣正确部署，无软组织嵌顿。无化脓性关节炎报告。9 例（2.9%）患者因纽扣引起 ITB 刺激出现外侧疼痛。其中 5 例在康复过程中症状缓解。4 例患者平均延迟 14.5±4.8 个月（11.7-21.7）后行超声引导下皮质类固醇浸润治疗。3 例患者症状缓解，但 1 例患者在手术后 27.5 个月需要手术取出植入物。关于无关的股骨纽扣并发症，15 例（4.9%）患者接受了二次关节镜手术，包括半月板切除术（1.6%）、单侧髁间棘切除术（2.6%）和 ACLR 翻修术（0.7%）。
结论
关节镜确认股骨纽扣的部署可防止软组织嵌顿，且无特定并发症。
证据等级
IV 级。
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