Cruz Christian A, Mannino Brian J, Venrick Connor B, Miles Rebecca N, Peterson David R, Zhou Liang, Min Kyong S, Bottoni Craig R
Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
Orthop J Sports Med. 2023 Feb 16;11(2):23259671221142315. doi: 10.1177/23259671221142315. eCollection 2023 Feb.
Anterior cruciate ligament (ACL) repair had previously been considered the standard of care for a ruptured ACL; however, ACL reconstruction has became the standard of care because of poor midterm outcomes after ACL repair. Recently, studies have suggested that the treatment paradigm should shift back to ACL repair.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the outcomes of ACL repair augmented with suture tape in a high-demand military population. We hypothesized that for proximal ACL avulsions, ACL repair with suture tape augmentation would lead to acceptable failure rates, satisfactory knee stability, excellent functional outcomes, and high rates of return to preinjury activity levels.
Case series; Level of evidence, 2.
Patients who were treated with ACL repair by a single surgeon between March 2017 and June 2019 and who had a minimum of 2 years of follow-up were included. Intraoperatively, all patients first underwent an arthroscopic examination. If an ACL avulsion of the proximal insertion with adequate remaining tissue was visualized, then ACL repair was performed. The primary outcome assessed was ACL repair failure, defined as reruptures or clinical instability requiring revision to ACL reconstruction. Analysis of the risk factors for ACL repair failure was conducted, with age at surgery, sex, body mass index, level of competition, and tobacco use evaluated.
Included were 46 patients (32 male and 14 female; mean age, 28.3 ± 8.4 years) who underwent ACL repair with suture tape augmentation. There were 12 cases of failure (26.1%; 8 male and 4 female). The mean time from injury to surgery in the failure group was 164.1 ± 59.4 days compared to 107.3 ± 98.0 days in the nonfailure group ( = .02). According to multivariate regression analysis, patients aged ≤17 and ≥35 years, elite/competitive/operational patients, and current smokers had a higher chance of ACL repair failure. The mean time to pass a military physical fitness test was 5.0 months. There were no complications other than ACL repair failure.
Primary arthroscopic ACL repair with suture tape augmentation resulted in unacceptably high failure rates at a minimum of 2 years of follow-up in a highly active military population. Age ≤17 and ≥35 years, elite level of competition, time from injury to surgery, and active tobacco use were independent risk factors for ACL repair failure.
前交叉韧带（ACL）修复术曾被认为是ACL断裂的标准治疗方法；然而，由于ACL修复术后中期效果不佳，ACL重建已成为标准治疗方法。最近，研究表明治疗模式应重新转向ACL修复。
目的/假设：本研究的目的是评估在高需求军事人群中使用缝线带增强ACL修复的效果。我们假设，对于近端ACL撕脱伤，使用缝线带增强的ACL修复将导致可接受的失败率、令人满意的膝关节稳定性、出色的功能结果以及高比例的恢复到伤前活动水平。
病例系列；证据等级，2级。
纳入2017年3月至2019年6月间由单一外科医生进行ACL修复且至少随访2年的患者。术中，所有患者首先接受关节镜检查。如果可见近端插入处的ACL撕脱且有足够的剩余组织，则进行ACL修复。评估的主要结果是ACL修复失败，定义为再次断裂或临床不稳定需要翻修为ACL重建。对ACL修复失败的危险因素进行分析，评估手术时的年龄、性别、体重指数、竞争水平和吸烟情况。
纳入46例接受缝线带增强ACL修复的患者（32例男性和14例女性；平均年龄28.3±8.4岁）。有12例失败（26.1%；8例男性和4例女性）。失败组从受伤到手术的平均时间为164.1±59.4天，而非失败组为107.3±98.0天（P = 0.02）。根据多因素回归分析，年龄≤17岁和≥35岁的患者、精英/竞技/作战患者以及当前吸烟者ACL修复失败的可能性更高。通过军事体能测试的平均时间为5.0个月。除ACL修复失败外无其他并发症。
在高度活跃的军事人群中，至少随访2年时，采用缝线带增强的初次关节镜下ACL修复导致了不可接受的高失败率。年龄≤17岁和≥35岁、精英竞争水平、受伤至手术的时间以及当前吸烟是ACL修复失败的独立危险因素。
