Département de chirurgie orthopédique et traumatologie unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHU de Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France.
DIM, unité de recherche clinique et épidémiologique, hôpital Lapeyronie, CHRU de Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier, France.
Orthop Traumatol Surg Res. 2022 May;108(3):103264. doi: 10.1016/j.otsr.2022.103264. Epub 2022 Mar 4.
Residual laxity can persist after anterior cruciate ligament (ACL) reconstruction. This increased anterior translation can be measured with a knee arthrometer. Nevertheless, the measurement parameters and functional impact of this residual laxity are not well understood. The aims of this study were to (1) evaluate the effect of applying loads of 134N, 200N and 250N on the measured residual laxity after ACL reconstruction and (2) evaluate the prognostic ability of the various measurement parameters on the functional outcomes.
After ACL reconstruction, the functional outcomes will be correlated to the postoperative residual laxity.
We did a prospective study of 61 recreational athletes who underwent surgical reconstruction of their ACL with the Kenneth-Jones technique between 2016 and 2019. The mean age of these patients was 27±7 years, and most were men (75%). The side-to-side difference in laxity was measured pre- and postoperatively using the GNRB® arthrometer at three load levels: 134N, 200N and 250N. The functional outcomes were determined based on the return to sports and the KOOS, IKDC and ARPEGE scores. The mean follow-up was 30±10 months.
Half the patients had returned to sport at their pre-injury levels, while 25% had returned to a lower level and 25% had stopped doing any physical activity. At 134N, a 1-mm increase in side-to-side difference was associated with a 2-fold higher risk of not returning to sports (OR 2; 95% CI 1.22-3.23; p<0.01). At 200N, a 1-mm increase in side-to-side difference was associated with a 50% higher probability of having a poor/fair ARPEGE score (OR 1.5; 95% CI 1.05-2.02; p=0.02). At 200N, a 4-mm side-to-side difference was the prognostic threshold for failure to return to sports with a positive predictive value of 86% and specificity of 98%.
This case series found a strong correlation between residual laxity and the functional outcomes after ACL reconstruction. A threshold of 4mm residual laxity evaluated on the GNRB® at 200N was predictive of adverse outcomes and failure to return to sports in our population of recreational athletes.
IV, retrospective study.
前交叉韧带（ACL）重建后可能仍存在残余松弛。这种增加的前向平移可以通过膝关节关节测径仪测量。然而，这种残余松弛的测量参数和功能影响尚不清楚。本研究的目的是：（1）评估在 ACL 重建后施加 134N、200N 和 250N 载荷对测量残余松弛的影响；（2）评估各种测量参数对功能结果的预后能力。
ACL 重建后，功能结果将与术后残余松弛相关。
我们进行了一项前瞻性研究，纳入了 2016 年至 2019 年间接受 Kenneth-Jones 技术手术重建 ACL 的 61 名娱乐运动员。这些患者的平均年龄为 27±7 岁，大多数为男性（75%）。使用 GNRB®关节测径仪在三个载荷水平（134N、200N 和 250N）测量术前和术后的松弛度侧别差值。根据重返运动和 KOOS、IKDC 和 ARPEGE 评分来确定功能结果。平均随访时间为 30±10 个月。
一半的患者恢复到术前的运动水平，25%的患者恢复到较低水平，25%的患者停止了任何体育活动。在 134N 时，侧别差值增加 1mm 与不重返运动的风险增加 2 倍相关（OR 2；95%CI 1.22-3.23；p<0.01）。在 200N 时，侧别差值增加 1mm 与 ARPEGE 评分差/差的可能性增加 50%相关（OR 1.5；95%CI 1.05-2.02；p=0.02）。在 200N 时，4mm 的侧别差值是预测运动失败的预后阈值，阳性预测值为 86%，特异性为 98%。
本病例系列研究发现 ACL 重建后残余松弛与功能结果之间存在很强的相关性。在我们的娱乐运动员人群中，200N 时 GNRB®上测量的 4mm 残余松弛阈值可预测不良结果和运动失败。
IV，回顾性研究。
