Cristiani Riccardo, Mouton Caroline, Siboni Renaud, Pioger Charles, Seil Romain
Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Valhallavägen 91, 11486, Stockholm, Sweden.
J Exp Orthop. 2022 Aug 17;9(1):79. doi: 10.1186/s40634-022-00519-2.
Dynamic Intraligamentary Stabilization (DIS) is a technique for the repair of acute anterior cruciate ligament (ACL) injuries. The purpose of this study was to investigate the potential challenges of ACL reconstruction (ACLR) following failure of DIS.
A retrospective analysis of patients with failure of primary ACL repair performed with DIS was undertaken. Failure was defined as abnormal knee laxity (positive Lachman and/or pivot shift) and/or severely restricted range of motion. Medical and surgical records were reviewed and preoperative standard anteroposterior and lateral X-rays were assessed.
Between July 2015 and May 2022, 10 patients (3 males, 7 females, median age 28 years, range 18-52 years) with failure of DIS were referred to and surgically treated at a single centre. In four patients, single-stage ACLR was performed following the removal of the tibial monoblock. In six patients, arthrofibrosis and excessive tibial tunnel enlargement following the removal of the monoblock prevented single-stage ACLR. These patients underwent arthroscopic arthrolysis and tibial tunnel bone grafting as a first-stage revision procedure.
In the present case series, single-stage ACLR was performed in only four (40%) of ten patients following failure of ACL repair with DIS. Arthrofibrosis and excessive tibial tunnel enlargement following the removal of the monoblock prevented single-stage ACLR in six (60%) patients. It is important for clinicians to inform patients that, in the event of failure of ACL repair with DIS, they may run a high risk of undergoing two-stage ACLR.
Level IV, Case Series.
动态韧带内稳定术（DIS）是一种修复急性前交叉韧带（ACL）损伤的技术。本研究的目的是调查DIS失败后进行ACL重建（ACLR）的潜在挑战。
对采用DIS进行初次ACL修复失败的患者进行回顾性分析。失败定义为膝关节松弛异常（Lachman试验和/或轴移试验阳性）和/或活动范围严重受限。回顾医疗和手术记录，并评估术前标准前后位和侧位X线片。
2015年7月至2022年5月期间，10例DIS失败的患者（3例男性，7例女性，中位年龄28岁，范围18 - 52岁）被转诊至单一中心并接受手术治疗。4例患者在取出胫骨单块后进行了一期ACLR。6例患者在取出单块后出现关节纤维化和胫骨隧道过度扩大，无法进行一期ACLR。这些患者接受了关节镜下粘连松解术和胫骨隧道植骨作为一期翻修手术。
在本病例系列中，10例DIS修复ACL失败的患者中只有4例（40%）进行了一期ACLR。6例（60%）患者在取出单块后出现关节纤维化和胫骨隧道过度扩大，无法进行一期ACLR。临床医生告知患者，如果DIS修复ACL失败，他们可能面临较高的二期ACLR风险，这一点很重要。
IV级，病例系列。
