Ahn Jin-Hwan, Son Dong-Wook, Ahn Ji-Hyun, Park Dae-Won, Park Jun-Hyoung
Department of Orthopaedic Surgery, Saeum Hospital, Seoul, Republic of Korea.
Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Orthop J Sports Med. 2023 Mar 20;11(3):23259671221143996. doi: 10.1177/23259671221143996. eCollection 2023 Mar.
The remnant preservation of a primary vertical graft in revision anterior cruciate ligament reconstruction (ACLR) can benefit anteroposterior stability. However, studies that address this concept are rare.
To evaluate clinical outcomes of remnant preservation of primary vertical graft in revision ACLR.
Cohort study; Level of evidence, 3.
A total of 74 patients with revision ACLR were included in this retrospective study. Remnant preservation revision ACLR was performed only in patients with primary vertical grafts. The patients were divided into 2 groups according to whether the primary remnant vertical graft was preserved (remnant group; n = 48) or absent or sacrificed (no-remnant group; n = 26). The remnant group was further divided according to the degree of remnant tissue: sufficiently preserved subgroup (graft coverage, ≥50%; n = 25) and insufficiently preserved subgroup (graft coverage, <50%; n = 23). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective form, Lysholm score, Tegner activity scale, manual laxity tests, and side-to-side difference in anterior tibial translation on Telos stress radiographs.
The mean time to final follow-up was 40.7 ± 16.8 months. The remnant group showed more improved results in the postoperative Lachman test and Telos side-to-side difference than did the no-remnant group ( = .017 and .016, respectively). The post hoc test revealed that the side-to-side difference in laxity in the sufficiently preserved subgroup significantly outperformed that in the no-remnant group ( = .001), although no significant difference existed between the insufficiently preserved and no-remnant subgroups ( = .850). The postoperative IKDC subjective form, Lysholm score, and Tegner activity scale did not show significant differences between the 2 groups ( = .480, .277, and .883, respectively).
The remnant preservation of the primary vertical graft in revision ACLR may result in better anteroposterior stability. However, subjective outcomes in the remnant group did not exceed that of the no-remnant group. The subgroup analysis revealed that only sufficiently preserved remnants demonstrated better anteroposterior stability.
在翻修前交叉韧带重建术（ACLR）中保留原发垂直移植物的残端可有利于前后稳定性。然而，涉及这一概念的研究很少。
评估在翻修ACLR中保留原发垂直移植物残端的临床疗效。
队列研究；证据等级，3级。
本回顾性研究共纳入74例翻修ACLR患者。仅对有原发垂直移植物的患者进行保留残端的翻修ACLR。根据原发垂直移植物残端是否保留，将患者分为2组（保留残端组；n = 48）或无残端或已切除残端组（无残端组；n = 26）。保留残端组再根据残端组织程度进一步分组：保留充分亚组（移植物覆盖率≥50%；n = 25）和保留不充分亚组（移植物覆盖率<50%；n = 23）。使用国际膝关节文献委员会（IKDC）主观量表、Lysholm评分、Tegner活动量表、手法松弛试验以及Telos应力X线片上胫骨前移的左右差值评估临床疗效。
最终随访的平均时间为40.7±16.8个月。保留残端组术后Lachman试验和Telos左右差值的改善结果优于无残端组（分别为P = 0.017和P = 0.016）。事后检验显示，保留充分亚组的松弛度左右差值显著优于无残端组（P = 0.001），尽管保留不充分亚组与无残端亚组之间无显著差异（P = 0.850）。术后IKDC主观量表、Lysholm评分和Tegner活动量表在两组之间未显示出显著差异（分别为P = 0.480、P = 0.277和P = 0.883）。
在翻修ACLR中保留原发垂直移植物的残端可能会带来更好的前后稳定性。然而，保留残端组的主观疗效并未超过无残端组。亚组分析显示，只有保留充分的残端表现出更好的前后稳定性。
