Moon Hyun-Soo, Choi Chong-Hyuk, Kim Sungjun, Yoo Je-Hyun, Jung Min, Kwon Hyuk-Jun, Hong Yong-Jae, Kim Sung-Hwan
Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Arch Orthop Trauma Surg. 2023 Apr;143(4):2027-2036. doi: 10.1007/s00402-022-04467-5. Epub 2022 May 13.
This study aimed to (1) evaluate the short-term clinical outcomes of patients who underwent non-operative treatment for partial anterior cruciate ligament (ACL) tears diagnosed using the outpatient-based diagnostic criteria and (2) investigate the radiographic predictors distinguishing patients at risk of non-operative treatment failure.
From 2010 to 2019, patients diagnosed with partial ACL tears and treated with non-operative treatment were reviewed retrospectively. Patients were then classified into two groups: those who successfully responded to non-operative treatment (group S) and those who failed to respond to non-operative treatment and required surgical reconstruction within 6 months after injury (group F). ACL laxity, patient-reported outcomes (PROs), and several radiographic parameters were analyzed. To identify radiographic predictors related to clinical outcomes, radiographic parameters were compared between the groups, which were statistically matched for potential confounders (age and activity level) using inverse probability of treatment weighting.
A total of 44 patients were analyzed (mean age, 28.7 ± 8.7 years; 31 men), and classified into two groups (group S, 23 patients; group F, 21 patients). There were no significant differences in ACL laxity and PROs between the groups at 1 year after either non-operative treatment or surgical reconstruction. A comparison of radiographic parameters between the groups revealed significant differences in several parameters related to secondary signs of ACL injury. Subsequent regression analyses revealed that anterior tibial translation and extent of bone bruises were radiographic predictors related to clinical outcomes.
Non-operative treatment for partial ACL tears diagnosed using the outpatient-based diagnostic criteria can provide successful short-term clinical outcomes in selective patients. Secondary signs of ACL injuries, particularly the amount of anterior tibial translation and the extent of bone bruises, are radiographic predictors that could differentiate patients at risk of non-operative treatment failure.
Retrospective cohort study, III.
本研究旨在（1）评估采用门诊诊断标准诊断为部分前交叉韧带（ACL）撕裂的患者接受非手术治疗的短期临床结果，以及（2）研究区分有非手术治疗失败风险患者的影像学预测指标。
回顾性分析2010年至2019年诊断为部分ACL撕裂并接受非手术治疗的患者。然后将患者分为两组：对非手术治疗成功反应的患者（S组）和对非手术治疗无反应且在受伤后6个月内需要手术重建的患者（F组）。分析ACL松弛度、患者报告结局（PROs）和几个影像学参数。为了确定与临床结果相关的影像学预测指标，比较了两组之间的影像学参数，并使用治疗权重的逆概率对潜在混杂因素（年龄和活动水平）进行了统计学匹配。
共分析了44例患者（平均年龄28.7±8.7岁；31例男性），并分为两组（S组23例患者；F组21例患者）。在非手术治疗或手术重建后1年，两组之间的ACL松弛度和PROs无显著差异。两组之间影像学参数的比较显示，与ACL损伤继发征象相关的几个参数存在显著差异。随后的回归分析显示，胫骨前移和骨挫伤范围是与临床结果相关的影像学预测指标。
采用门诊诊断标准诊断为部分ACL撕裂的患者进行非手术治疗，可在部分患者中提供成功的短期临床结果。ACL损伤的继发征象，特别是胫骨前移量和骨挫伤范围，是可以区分有非手术治疗失败风险患者的影像学预测指标。
回顾性队列研究，III级。
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