Szakiel Paulina M, Aksu Nicholas E, Kirloskar Kunal M, Gruber Maxwell D, Zittel Kyle W, Grieme Caleb V, Geng Xue, Argintar Evan H
Georgetown University School of Medicine, Washington, D.C, USA.
Elson S. Floyd College of Medicine, Spokane, WA, USA.
J Orthop. 2022 Jul 16;33:95-99. doi: 10.1016/j.jor.2022.07.002. eCollection 2022 Sep-Oct.
The purpose of this study was to compare surgical outcomes in patients who underwent ACL reconstruction, with and without internal bracing, at 1-3, 4-7, and 8-12 months of postoperative physical therapy. Previous studies show that ACL reconstruction with internal bracing allows earlier and more aggressive rehabilitation. Therefore, it was hypothesized that patients with internal bracing would display superior surgical recovery compared to ACL reconstruction alone after adjusting for length of physical therapy.1, 2, 3.
Patients who underwent ACL reconstruction and had a minimum two-year follow-up were included. Demographics including age, gender, use of internal bracing, and pre-operative level of activity were collected. Patient-reported outcomes were assessed using KOOS scores.
46 patients underwent ACL reconstruction between January 2013 and December 2015. The mean age was 31.53 ± 8.37 years. Patients who received ACL reconstruction with internal bracing reported similar improvement in KOOS scores (mean = 42.82 ± 15.44; median = 46.39 [34.52-51.80]) compared to ACL reconstruction alone (mean = 38.18 ± 19.91; median = 40.17 [29.49-53.90]) (p = 0.475). Patients who received ACL reconstruction with internal bracing reported comparable improvement to ACL reconstruction alone at 0-3 months (Internal bracing: mean = 35.39 ± 15.26, median = 40.45 [26.49-47.73]; No internal bracing: mean = 42.51 ± 12.33, median = 39.32 [35.69-52.94], p = 0.4113), 4-7 months (Internal bracing: 41.96 ± 14.49, 45.55 [33.94-52.68]; No internal bracing: 30.64 ± 32.29, 41.65 [26.17-46.12], p = 0.7491) and 8+ months groups (Internal bracing: 63.36 ± 13.06, 63.36 [58.74-67.98]; No internal bracing: 47.05 ± 10.14, 47.05 [43.46-50.63]) (p = 0.6985).
This study demonstrates no statistical difference in functional outcome scores when comparing patients with internally braced ACL reconstruction compared to standard reconstruction. Therefore, the increased structural support provided by use of internal bracing in ACL reconstruction does not afford to quicker improvement in patient-reported recovery.
本研究旨在比较接受前交叉韧带重建术的患者在术后1 - 3个月、4 - 7个月和8 - 12个月进行物理治疗时，使用和不使用内置支撑的手术效果。先前的研究表明，采用内置支撑的前交叉韧带重建术能使患者更早且更积极地进行康复训练。因此，研究假设在调整物理治疗时长后，与单纯的前交叉韧带重建术相比，采用内置支撑的患者手术恢复情况更佳。1, 2, 3
纳入接受前交叉韧带重建术且至少有两年随访期的患者。收集患者的人口统计学信息，包括年龄、性别、是否使用内置支撑以及术前活动水平。使用膝关节损伤和骨关节炎疗效评分（KOOS）评估患者报告的预后情况。
2013年1月至2015年12月期间，46例患者接受了前交叉韧带重建术。平均年龄为31.53 ± 8.37岁。与单纯进行前交叉韧带重建术的患者相比（平均 = 38.18 ± 19.91；中位数 = 40.17 [29.49 - 53.90]），接受内置支撑的前交叉韧带重建术的患者报告的KOOS评分改善情况相似（平均 = 42.82 ± 15.44；中位数 = 46.39 [34.52 - 51.80]）（p = 0.475）。接受内置支撑的前交叉韧带重建术的患者在0 - 3个月（内置支撑：平均 = 35.39 ± 15.26，中位数 = 40.45 [26.49 - 47.73]；无内置支撑：平均 = 42.51 ± 12.33，中位数 = 39.32 [35.69 - 52.94]，p = 0.4113）、4 - 7个月（内置支撑：41.96 ± 14.49，45.55 [33.94 - 52.68]；无内置支撑：30.64 ± 32.29，41.65 [26.17 - 46.12]，p = 0.7491）和8个月以上组（内置支撑：63.36 ± 13.06，63.36 [58.74 - 67.98]；无内置支撑：47.05 ± 10.14，47.05 [43.46 - 50.63]）（p = 0.6985）报告的改善情况与单纯前交叉韧带重建术相当。
本研究表明，与标准重建相比，比较接受内置支撑的前交叉韧带重建术的患者与单纯重建术患者的功能预后评分无统计学差异。因此，在前交叉韧带重建术中使用内置支撑所提供的额外结构支撑，并不能使患者报告的恢复情况更快得到改善。
