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使用钛制可调袢纽扣和聚-L-共-DL-乳酸-β-磷酸三钙(PLDLA-bTCP)干涉螺钉进行前交叉韧带重建的功能结果:一项单中心、回顾性、观察性研究。

Functional Outcomes of Anterior Cruciate Ligament Reconstruction Using Titanium Adjustable Loop Button and Poly-L-co-DL-Lactic Acid-Beta Tricalcium Phosphate (PLDLA-bTCP) Interference Screws: A Single-Center, Retrospective, Observational Study.

作者信息

Sharma Pulak, Baghel Anurag, Keshav Kumar, Kumar Amit, Singh Abhishek, Singh Amarendra B

机构信息

Orthopaedics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND.

出版信息

Cureus. 2023 Feb 2;15(2):e34542. doi: 10.7759/cureus.34542. eCollection 2023 Feb.

Abstract

Background The anterior cruciate ligament (ACL) reconstruction is a standard surgery in patients with instability of the knee caused by ACL insufficiency. Several differential procedures using grafts and implants such as loops, buttons, and screws have been described. This study aimed to assess the functional outcomes of ACL reconstruction surgery using titanium adjustable loop buttons and poly-L-co-DL-lactic acid-beta tricalcium phosphate (PLDLA-bTCP) interference screws. Methodology This was a retrospective, observational, single-center, and clinical study. A total of 42 patients who underwent ACL reconstruction at a tertiary trauma center in northern India between 2018 and 2022 were recruited. Data including demographics, details of the injury, surgery, implants, and surgical outcomes were collected from the patients' medical records. Further, post-surgery details such as re-injury, adverse events, International Knee Documentation Committee (IKDC) profiles, and Lysholm knee score were recorded from the enrolled patients through a telephonic follow-up. Pain score and Tegner activity scale were used to compare the knee status before and after surgery. Results At the time of surgery, the mean age of the recruited patients was 31.1 ± 8.8 years, with a male preponderance of 93%. About 57% of patients had left knee injuries. The common symptoms were instability (67%), pain (62%), swelling (14%), and giving away (5%). During surgery, titanium adjustable loop button and PLDLA-bTCP interference screw implants were used in all patients. The mean follow-up time was 21.2 ± 14.2 months. Based on patient responses, the mean IKDC and Lysholm scores were found to be 54.02 ± 5.93 and 94.4 ± 4.73, respectively. Further, the proportion of patients reporting pain decreased from 62% before surgery to 21% after surgery. The mean Tegner score revealed a significant increase in the activity levels of the patients post-surgery compared to pre-surgery (p < 0.05). Lastly, no adverse events or re-injuries were reported in any of the patients during follow-up. Conclusions Our findings revealed a significant improvement in Tegner activity levels and pain scores after surgery. In addition, patient-reported IKDC and Lysholm scores fell under the category of good knee status and function, suggesting a satisfactory functional outcome of ACL reconstruction. Hence, titanium adjustable loop and PLDLA-bTCP interference screws may be a good choice of implants for successful ACL reconstruction surgery.

摘要

背景

前交叉韧带(ACL)重建术是治疗ACL功能不全导致膝关节不稳患者的标准手术。已有多种使用移植物和植入物(如袢、纽扣和螺钉)的不同手术方法被描述。本研究旨在评估使用钛制可调袢纽扣和聚-L-共-DL-乳酸-β-磷酸三钙(PLDLA-bTCP)干涉螺钉进行ACL重建手术的功能结果。

方法

这是一项回顾性、观察性、单中心临床研究。招募了2018年至2022年期间在印度北部一家三级创伤中心接受ACL重建的42例患者。从患者病历中收集包括人口统计学、损伤细节、手术、植入物和手术结果等数据。此外,通过电话随访从入组患者中记录术后再损伤、不良事件、国际膝关节文献委员会(IKDC)评分和Lysholm膝关节评分等细节。使用疼痛评分和Tegner活动量表比较手术前后的膝关节状况。

结果

手术时,招募患者的平均年龄为31.1±8.8岁,男性占比93%。约57%的患者为左膝损伤。常见症状为膝关节不稳(67%)、疼痛(62%)、肿胀(14%)和打软腿(5%)。手术过程中,所有患者均使用了钛制可调袢纽扣和PLDLA-bTCP干涉螺钉植入物。平均随访时间为21.2±14.2个月。根据患者的回答,平均IKDC和Lysholm评分分别为54.02±5.93和94.4±4.73。此外,报告疼痛的患者比例从术前的62%降至术后的21%。平均Tegner评分显示,与术前相比,患者术后的活动水平显著提高(p<0.05)。最后,随访期间所有患者均未报告不良事件或再损伤。

结论

我们的研究结果显示,术后Tegner活动水平和疼痛评分有显著改善。此外,患者报告的IKDC和Lysholm评分属于膝关节状况和功能良好的类别,表明ACL重建的功能结果令人满意。因此,钛制可调袢和PLDLA-bTCP干涉螺钉可能是成功进行ACL重建手术的良好植入物选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/43d4/9985307/4d97f2758707/cureus-0015-00000034542-i01.jpg

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