Eberlein Sophie C, Rodriguez Vanessa, Hecker Andreas, Schürholz Katharina, Ahmad Sufian S, Klenke Frank M
Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 4, 3010, Bern, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Kantonsspital Aarau, Aarau, Switzerland.
J Exp Orthop. 2022 Aug 8;9(1):77. doi: 10.1186/s40634-022-00517-4.
Anterior cruciate ligament (ACL) repair has been recommended as a treatment principle for ACL tears. Several authors have advocated a potential role for primary repair techniques in the ACL decision tree. However, long-term results have been controversial. This study aims to determine the survival of the primarily repaired ACL after dynamic intraligamentary stabilization (DIS) with and without augmentation.
Between 2014 and 2019, 102 patients with isolated proximal ACL ruptures underwent DIS repair within 21 days from injury and were available for follow-up either clinically or telephonically after ≥5 years postoperatively. In 45 cases, DIS repair was augmented with collagen fleece wrapping, platelet-rich fibrin (PRF) or both. Failure was defined as traumatic re-rupture or conversion to ACL reconstruction. The patients being available for physical examination underwent a.-p. stability measurement with a KT-1000 device. Functional outcome was measured with the IKDC, Tegner and Lysholm scores. Kaplan-Meier survival analysis, Log-Rank Test and Binominal logistic regression were performed.
After a minimum 5-year follow-up, 71/102 (69.6%) DIS repairs were not re-reptured and clinically and/or subjectively stable. Augmentation did not improve survival rates (p = 0.812). The identified factors influencing failure were a younger age and a pre-injury Tegner activity level of ≥7. 95.7% of those patients with an intact ACL repair had normal or near normal knee function based on the IKDC scoring system.
The 5-year overall survival rate of DIS was 69.6%. Collagen fleece wrapping and local PRF application did not improve survival. Patients not suffering failure of repair demonstrated high satisfaction. Nevertheless, the results are inferior to those of established ACL reconstruction procedures.
Case series, Level IV.
前交叉韧带（ACL）修复已被推荐为ACL撕裂的治疗原则。几位作者主张在ACL治疗决策中采用一期修复技术。然而，长期结果一直存在争议。本研究旨在确定动态韧带内稳定术（DIS）联合或不联合增强术对一期修复的ACL的保留率。
2014年至2019年期间，102例孤立性近端ACL断裂患者在受伤后21天内接受了DIS修复，术后≥5年可进行临床或电话随访。45例患者采用胶原纤维包裹、富血小板纤维蛋白（PRF）或两者联合增强DIS修复。失败定义为创伤性再断裂或转为ACL重建。接受体格检查的患者使用KT-1000设备进行前后向稳定性测量。功能结果采用IKDC、Tegner和Lysholm评分进行评估。进行了Kaplan-Meier生存分析、Log-Rank检验和二项逻辑回归分析。
经过至少5年的随访，71/102（69.6%）例DIS修复未再次断裂，临床和/或主观上稳定。增强术并未提高保留率（p = 0.812）。确定的影响失败的因素是年龄较小和伤前Tegner活动水平≥7。根据IKDC评分系统，95.7%的ACL修复完整的患者膝关节功能正常或接近正常。
DIS的5年总保留率为69.6%。胶原纤维包裹和局部应用PRF并未提高保留率。未发生修复失败的患者满意度较高。然而，结果低于既定的ACL重建手术。
病例系列，IV级。
