Lin Lin, Wang Hai-Jun, Wang Yong-Jian, Wang Jian, Chen You-Rong, Yu Jia-Kuo
Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.
Institute of Sports Medicine of Peking University, Beijing, China.
Am J Sports Med. 2023 Mar;51(3):634-641. doi: 10.1177/03635465221148746. Epub 2023 Feb 3.
There are limited studies designed by matching related factors to compare clinical outcomes and return to sport (RTS) between patients undergoing revision anterior cruciate ligament reconstruction (R-ACLR) and primary ACLR (P-ACLR).
(1) To compare the outcomes between R-ACLR and P-ACLR in a matched-pair analysis with 3- to 5-year follow-up and (2) to evaluate patient-reported factors for not returning to preinjury-level sport.
Cohort study; Level of evidence, 4.
Patients who underwent R-ACLR between September 2016 and November 2018 were propensity matched by age, sex, body mass index, passive anterior tibial subluxation, and generalized hypermobility in a 1:1 ratio to patients who underwent P-ACLR during the same period. By combining in person follow-up at 2 years postoperatively and telemedicine interview at the final follow-up (January 2022), knee stability and clinical scores were compared, including International Knee Documentation Committee (IKDC), Lysholm, and Tegner. Status of RTS was requested, specifically whether the patient returned to preinjury level of sport. Patient-reported reasons for not returning were analyzed.
There were 63 matched pairs in the present study. Knee stability was similar in terms of KT-2000 arthrometer, Lachman test, and pivot-shift test results between the groups at 2 years of follow-up. At the final follow-up, no significant difference was found between groups for postoperative clinical scores (IKDC, Tegner, and Lysholm) ( > .05). There was a significant difference in total RTS: 53 (84.1%) in the P-ACLR cohort and 41 (65.1%) in the R-ACLR cohort ( = .014). No significant difference was shown in terms of RTS at the same level: 35 (55.6%) in P-ACLR and 31 (49.2%) in R-ACLR ( = .476). Significantly more patients showed fear of reinjury: 26 of 32 (81.3%) in the R-ACLR group as compared with 15 of 28 (53.5%) in the P-ACLR group ( < .021).
R-ACLR resulted in similar clinical scores (IKDC, Tegner, and Lysholm) but significantly lower RTS versus P-ACLR at 3 to 5 years of follow-up. Fear of reinjury was the most common factor that caused sport changes in patients with R-ACLR.
通过匹配相关因素来比较翻修前交叉韧带重建术（R-ACLR）患者与初次前交叉韧带重建术（P-ACLR）患者的临床结果和恢复运动（RTS）情况的研究有限。
（1）在3至5年随访的配对分析中比较R-ACLR和P-ACLR的结果，（2）评估患者报告的未恢复到伤前运动水平的因素。
队列研究；证据等级，4级。
2016年9月至2018年11月期间接受R-ACLR的患者按年龄、性别、体重指数、被动胫骨前移和全身关节过度活动以1:1的比例与同期接受P-ACLR的患者进行倾向评分匹配。通过结合术后2年的面对面随访和最终随访（2022年1月）的远程医疗访谈，比较膝关节稳定性和临床评分，包括国际膝关节文献委员会（IKDC）、Lysholm和Tegner评分。询问RTS状态，特别是患者是否恢复到伤前运动水平。分析患者报告的未恢复运动的原因。
本研究中有63对匹配病例。随访2年时，两组间在KT-2000关节测量仪、Lachman试验和轴移试验结果方面的膝关节稳定性相似。在最终随访时，两组间术后临床评分（IKDC、Tegner和Lysholm）无显著差异（P>0.05）。总RTS存在显著差异：P-ACLR队列中有53例（84.1%），R-ACLR队列中有41例（65.1%）（P=0.014）。在同一运动水平上的RTS无显著差异：P-ACLR组为35例（55.6%），R-ACLR组为31例（49.2%）（P=0.476）。明显更多的患者表现出再次受伤的恐惧：R-ACLR组32例中有26例（81.3%），而P-ACLR组28例中有15例（53.5%）（P<0.021）。
在3至5年随访时，R-ACLR导致的临床评分（IKDC、Tegner和Lysholm）相似，但与P-ACLR相比，RTS显著更低。再次受伤的恐惧是导致R-ACLR患者运动改变的最常见因素。
