Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA.
University of Missouri, Columbia, Missouri, USA.
Am J Sports Med. 2022 Jul;50(9):2397-2409. doi: 10.1177/03635465221104470.
Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described.
To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting.
Cohort study; Level of evidence, 3.
A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics.
A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (≤ .001). Patients who required 2-stage grafting had more previous ACLRs ( < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (≤ .008) and less likely to receive a soft tissue autograft (≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group.
Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.
在翻修前交叉韧带重建（rACLR）手术中，可能需要对裂解或错位的隧道进行植骨。患者特征以及植骨对 rACLR 后结果的影响尚未得到很好的描述。
描述接受 rACLR 且行植骨手术患者与未行植骨患者的术前特征、术中发现和 2 年随访结果。
队列研究；证据等级，3 级。
2006 年至 2011 年期间前瞻性纳入了 1234 例接受 rACLR 的患者。收集了基线翻修和 2 年随访的特征、手术技术、病理、治疗和患者报告的结局评估工具（国际膝关节文献委员会[IKDC]、膝关节损伤和骨关节炎结局评分[KOOS]、西部安大略省和麦克马斯特大学骨关节炎指数和 Marx 活动评分量表[Marx]），以及后续的手术信息（如果适用）。采用卡方检验和方差分析比较组间特征。
共有 159 例患者（13%）接受了隧道植骨-64 例（5%）患者行 1 期植骨，95 例（8%）患者行 2 期植骨。31 例（2.5%）患者仅行股骨植骨，40 例（3%）患者仅行胫骨植骨，88 例（7%）患者行联合植骨。2 期植骨组的基线 KOOS 生活质量（QoL）和 Marx 活动评分明显低于无植骨组（≤.001）。需要 2 期植骨的患者 ACLR 病史更多（<.001），并且初次 ACLR 时更不可能接受骨-髌腱-骨或自体组织移植物（≤.021）。对于当前 rACLR，行 1 期或 2 期植骨的患者更有可能接受骨-髌腱-骨同种异体移植物（≤.008），而不太可能接受自体组织移植物（≤.003）。在 1052 例（85%）患者的 2 年随访中，我们发现 2 期植骨组的结局较差（IKDC 评分=68；KOOS QoL 评分=44；KOOS 运动/娱乐评分=65；Marx 活动评分=3），与无植骨组（IKDC 评分=77；KOOS QoL 评分=63；KOOS 运动/娱乐评分=75；Marx 活动评分=7）相比（≤.01）。1 期植骨组与无植骨组相比，差异无统计学意义。
在我们的 rACLR 队列中，有 13%的患者行隧道植骨，其中 8%的患者行 2 期手术。与未行植骨的患者相比，行 2 期植骨的患者基线和 2 年随访的患者报告结局和活动水平较差。行 1 期植骨的患者与未行植骨的患者相比，基线和 2 年随访的患者报告结局和活动水平相似。
