Helito Camilo Partezani, Sobrado Marcel Faraco, Moreira da Silva Andre Giardino, Castro de Pádua Vitor Barion, Guimarães Tales Mollica, Bonadio Marcelo Batista, Pécora José Ricardo, Gobbi Riccardo Gomes, Camanho Gilberto Luis
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP; Hospital Sírio Libanês, São Paulo - SP.
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo - SP.
Arthroscopy. 2023 Feb;39(2):308-319. doi: 10.1016/j.arthro.2022.06.039. Epub 2022 Jul 15.
To compare the failure rate in patients who underwent revision anterior cruciate ligament (ACL) reconstruction alone or associated with an extra-articular procedure. Secondary objectives were to compare ACL laxity, patient-reported outcome measures, and complication rates in these patients and, subsequently, to compare the outcomes of patients who underwent revision ACL reconstruction associated with anatomical anterolateral ligament (ALL) reconstruction or lateral extra-articular tenodesis (LET).
This was a retrospective comparative study. Patients were classified into 2 groups, according to whether (group 2) or not (group 1) an extra-articular reconstruction was performed. Patients who underwent an extra-articular procedure were further divided into ALL reconstruction (group 2A) and LET (group 2B). Baseline demographic variables, operative data and postoperative data were evaluated.
The groups with (86 patients) and without (88 patients) an associated extra-articular reconstruction had similar preoperative data. Group 2 had a lower failure rate (4.6% vs 14.7%; P = .038), better KT-1000, better pivot-shift, and better Lysholm. There was no difference regarding complications, except more lateral pain in group 2. Regarding the groups who underwent ALL reconstruction (41 patients) and LET (46 patients), group 2A showed better Lysholm scores. Both groups had similar failure rates and complications.
Patients who underwent revision ACL reconstruction with a laterally based augmentation procedure had a lower failure rate than patients who underwent isolated revision ACL reconstruction. KT-1000 and pivot-shift examination were also significantly better when a lateral augmentation was performed. Complications were similar except for an increase in lateral pain in the augmented group. No clinically important differences were found when comparing the LET group to the ALL group other than a statistical improvement in the Lysholm functional scale, likely not clinically meaningful, favoring the ALL group and an increased duration of post-operative lateral pain in the LET group.
III, retrospective comparative therapeutic trial.
比较单纯接受前交叉韧带（ACL）翻修重建手术的患者与同时接受关节外手术的患者的失败率。次要目标是比较这些患者的ACL松弛度、患者报告的结局指标和并发症发生率，随后比较接受与解剖学前外侧韧带（ALL）重建或外侧关节外肌腱固定术（LET）相关的ACL翻修重建手术的患者的结局。
这是一项回顾性比较研究。根据是否进行关节外重建手术，将患者分为两组（第2组）或未进行关节外重建手术的组（第1组）。接受关节外手术的患者进一步分为ALL重建组（第2A组）和LET组（第2B组）。评估基线人口统计学变量、手术数据和术后数据。
进行（86例患者）和未进行（88例患者）相关关节外重建手术的两组患者术前数据相似。第2组的失败率较低（4.6%对14.7%；P = 0.038），KT-1000测量结果更好，轴移试验结果更好，Lysholm评分更高。并发症方面无差异，只是第2组外侧疼痛更多。在接受ALL重建（41例患者）和LET（46例患者）的组中，第2A组的Lysholm评分更高。两组的失败率和并发症相似。
接受基于外侧增强手术的ACL翻修重建手术的患者的失败率低于单纯接受ACL翻修重建手术的患者。进行外侧增强手术时，KT-1000测量结果和轴移试验也明显更好。除增强组外侧疼痛增加外，并发症相似。比较LET组和ALL组时，除Lysholm功能量表有统计学上的改善（可能无临床意义）且有利于ALL组，以及LET组术后外侧疼痛持续时间增加外，未发现具有临床重要性的差异。
III级，回顾性比较治疗试验。
