Vanderbilt University, Nashville, Tennessee, USA.
Washington University in St Louis, St Louis, Missouri, USA.
Am J Sports Med. 2023 Mar;51(3):605-614. doi: 10.1177/03635465231151389. Epub 2023 Feb 3.
Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction.
To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient's outcome at 6-year follow-up.
Cohort study; Level of evidence, 3.
Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction.
An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; ≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation ( < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores ( < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years.
Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.
在前交叉韧带（ACL）重建翻修术中，半月板和软骨损伤很常见。
确定在 ACL 翻修手术时半月板和/或关节软骨病变是否会显著影响患者 6 年随访时的结果。
队列研究；证据水平，3 级。
2006 年至 2011 年间，前瞻性招募接受 ACL 翻修重建的患者。数据收集包括基线人口统计学、手术技术、病理、治疗以及 4 种经过验证的患者报告结局量表的评分：国际膝关节文献委员会（IKDC）、膝关节损伤和骨关节炎结果评分（KOOS）、西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）以及 Marx 活动评分量表。患者在 6 年时进行随访，并要求他们完成相同的一组结局量表。回归分析评估了半月板和关节软骨病变对 ACL 翻修重建后 6 年临床结局的风险因素。
共有 1234 例患者（716 例男性，58%；中位年龄 26 岁）入组。外科医生报告了在半月板内侧（45%）、半月板外侧（36%）、股骨内侧髁（43%）、股骨外侧髁（29%）、胫骨内侧平台（11%）、胫骨外侧平台（17%）、髌骨（30%）和滑车（21%）处的病变。对 1234 例患者中的 79%（980/1234）进行了 6 年随访。半月板病变和关节软骨病变（股骨内侧髁、股骨外侧髁、胫骨外侧平台、滑车和髌骨）是患者报告结局在 6 年时较差的显著驱动因素（IKDC、KOOS、WOMAC 和 Marx）。影响结局的最一致因素是内侧半月板切除（无论是在初次手术之前还是初次手术时）和髌股关节软骨病变。6 年 Marx 活动水平受到内侧半月板（无论是修复/切除）和髌骨软骨 3-4 级病变的负面影响（比值比范围，1.45-1.72；<.04）。在指数翻修手术之前发生的半月板病变对所有 KOOS 亚量表评分（除运动/娱乐亚量表外）均有负面影响（<.05）。关节软骨病变显著损害了所有 KOOS 亚量表评分（<.05）。较低的基线结局评分、较高的体重指数、吸烟以及随后发生的手术均显著增加了患者在 6 年时报告临床结局较差的可能性。
在前交叉韧带重建翻修术中，半月板和软骨病变对翻修手术后 6 年患者报告的结局仍有持续的显著不利影响。
