Department of Orthopedic and Trauma Surgery, University Hospital, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.
Schoen Clinic Munich Harlaching, Academic Teaching Hospital Munich University, Munich, Germany.
Arch Orthop Trauma Surg. 2022 Oct;142(10):2839-2847. doi: 10.1007/s00402-021-04269-1. Epub 2021 Dec 6.
The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL.
Cross-sectional study, Level of evidence III.
In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05).
24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78).
Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.
本研究旨在通过仪器测量客观评估初次前交叉韧带（ACL）断裂后再断裂的旋转松弛度。研究假设，与初次 ACL 断裂的膝关节相比，复发性不稳定的膝关节内旋松弛度更高。
横断面研究，证据等级 III。
在一项临床横断面研究中，连续评估了初次 ACL 断裂和 ACL 重建后再断裂的患者，分别通过仪器测量旋转和前后松弛度以及 KT1000 进行评估。临床检查包括 IKDC2000 表格、Lysholm 评分和 Tegner 活动量表。进行了功率计算和统计分析（p 值<0.05）。
纳入了 24 例初次 ACL 断裂和 23 例 ACL 再断裂的患者。前向平移无明显的侧别差异。再断裂组（53.6%）内旋松弛度的侧别差异≥10°明显比初次断裂组（19.4%）更常见（p<0.001）。可以证明，枢轴移位现象的严重程度与内旋松弛度的侧别差异之间存在高度显著的关系（p<0.001）。IKDC2000 主观评分显示，初次 ACL 撕裂患者的评分明显高于 ACL 再断裂患者（56.4±7.8 比 50.8±6.2；p=0.01）。初次 ACL 撕裂患者在 Tegner 活动量表上的评分明显更高（p=0.02）。Lysholm 评分无显著差异（p=0.78）。
ACL 再断裂患者的膝关节内旋松弛度明显高于初次 ACL 断裂患者。旋转松弛度可以通过仪器测量来量化。这对于 ACL 翻修手术中前外侧韧带重建的适应证具有重要意义。
