Suri Misty, Verma Arjun, Khalid Mohammed Asad, Nammour Michael, Godshaw Brian
Ochsner Sports Medicine Institute, Jefferson, LA.
The University of Queensland Medical School, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2023 Spring;23(1):27-33. doi: 10.31486/toj.22.0085.
Bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstruction is a frequently used technique but has been associated with a high incidence of postoperative anterior knee pain. However, previous studies have not evaluated if this anterior knee pain is functionally limiting for patients. This study introduces the concept of functional anterior knee pain, or kneecap pain that limits patients' ability to return to their prior level of activity or sport. We reviewed BPTB ACL reconstructions from April 2013 to May 2017. Patients included in the analysis had a minimum of 1 year of clinical follow-up and 3 years of survey follow-up. Statistical analyses were performed using paired tests and binomial test. Sixty-seven patients met the inclusion criteria. Compared to the mean preoperative visual analog scale (VAS) pain score of 6.1, patients reported statistically significant reductions in VAS scores at 1 year and 3 years postoperatively to 0.9 and 1.8, respectively (<0.01). The incidence (28.4%) of anterior knee pain was highest at the 3-month time point. This incidence decreased to 6.0% at 1 year and 7.5% at 3 years postoperatively. At 3 years postoperatively, 94% (63/67) of the patients in this study were not limited by functional anterior knee pain and returned to preoperative levels of activity and sport. To our knowledge, this investigation is the first to define and quantify the relationship between postoperative anterior knee pain and resultant functional limitations. This study shows that ACL reconstruction with BPTB autograft was not significantly associated with functional anterior knee pain in our population and that the incidence of postoperative anterior knee pain following BPTB ACL reconstruction may be less than previously reported.
髌腱-骨（BPTB）前交叉韧带（ACL）重建是一种常用技术，但术后前膝痛的发生率较高。然而，以往研究尚未评估这种前膝痛对患者功能的限制情况。本研究引入了功能性前膝痛的概念，即限制患者恢复至术前活动或运动水平的髌前疼痛。我们回顾了2013年4月至2017年5月期间的BPTB ACL重建病例。纳入分析的患者临床随访至少1年，调查随访至少3年。采用配对t检验和二项式检验进行统计学分析。67例患者符合纳入标准。与术前视觉模拟量表（VAS）疼痛评分均值6.1相比，患者术后1年和3年的VAS评分显著降低，分别降至0.9和1.8（P<0.01）。前膝痛的发生率在术后3个月时最高，为28.4%。术后1年该发生率降至6.0%，术后3年降至7.5%。术后3年，本研究中94%（63/67）的患者未受到功能性前膝痛的限制，恢复到了术前的活动和运动水平。据我们所知，本研究首次定义并量化了术后前膝痛与由此导致的功能受限之间的关系。本研究表明，在我们的研究人群中，采用BPTB自体移植物进行ACL重建与功能性前膝痛无显著相关性，且BPTB ACL重建术后前膝痛的发生率可能低于先前报道。
