单束前交叉韧带联合前外侧韧带重建与双束前交叉韧带重建在至少2年随访时的临床和影像学结果相似：一项前瞻性随机对照试验。
Single Bundle Anterior Cruciate Ligament With Anterolateral Ligament Reconstruction Yields Similar Clinical and Radiographic Results at Minimum 2-Year Follow-Up Versus Double Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Trial.
作者信息
Lee Sung-Sahn, Kwon Kyeu Baek, Lee Jeounghun, Ryu Dong Jin, Jang Seungpil, Wang Joon Ho
机构信息
Department of Orthopaedic Surgery, Ilsan Paik Hospital, Inje University School of Medicine, Goyangsi, Gyeonggido, Korea.
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
出版信息
Arthroscopy. 2023 Dec;39(12):2502-2512. doi: 10.1016/j.arthro.2023.04.022. Epub 2023 May 18.
PURPOSE
To compare the clinical, radiographic, and second-look arthroscopic outcomes between double-bundle (DB) anterior cruciate ligament (ACL) reconstruction (DB group) and combined single-bundle (SB) ACL and anterolateral ligament (ALL) reconstruction (SB + ALL group) by a prospective randomized controlled trial.
METHODS
From May 2019 to June 2020, 84 patients were enrolled in this study. Among them, 10 were lost to follow-up. Thirty-six and 38 patients were successfully allocated to the DB (mean follow up 27.3 ± 4.2 months) and SB + ALL groups (27.2 ± 4.5 months), respectively. The preoperative and postoperative Lachman test, pivot shift test, anterior translation on stress radiographs, KT-2000 arthrometer, Lysholm score, International Knee Documentation Committee score, and Tegner activity score were evaluated and compared. Graft continuity was evaluated using postoperative magnetic resonance imaging (MRI) (32 and 36 patients underwent MRI in the DB and SB + ALL groups at 7.4 ± 3.2 and 7.5 ± 2.9 months after surgery, respectively), and second-look examinations (second-look examination and tibial screw removal were performed concomitantly when patients (1) had tibial screw-related irritation or (2) needed the screws removed, 28 and 23 patients underwent examinations in the DB and SB + ALL groups at 24.0 ± 6.8 and 24.9 ± 8.1 months after surgery, respectively). All measurements were compared between the groups.
RESULTS
Postoperative clinical outcomes significantly improved in both groups. (All variables showed P < .001) No statistically different outcomes were found between the 2 groups. Additionally, postoperative graft continuity on MRI and second-look examinations were not different between the 2 groups.
CONCLUSIONS
The DB and SB + ALL groups showed similar postoperative clinical, radiographic, and second-look arthroscopic outcomes. Both groups showed excellent postoperative stability and clinical outcomes compared with the preoperative measurements.
LEVEL OF EVIDENCE
Level II, randomized controlled trial.
目的
通过前瞻性随机对照试验，比较双束（DB）前交叉韧带（ACL）重建术（DB组）与单束（SB）ACL联合前外侧韧带（ALL）重建术（SB + ALL组）的临床、影像学及二次关节镜检查结果。
方法
2019年5月至2020年6月，本研究纳入84例患者。其中，10例失访。36例和38例患者分别成功分配至DB组（平均随访27.3±4.2个月）和SB + ALL组（27.2±4.5个月）。对术前及术后的Lachman试验、轴移试验、应力位X线片上的前向移位、KT-2000关节测量仪、Lysholm评分、国际膝关节文献委员会评分及Tegner活动评分进行评估和比较。使用术后磁共振成像（MRI）评估移植物的连续性（DB组和SB + ALL组分别有32例和36例患者在术后7.4±3.2个月和7.5±2.9个月接受了MRI检查），并进行二次关节镜检查（当患者（1）出现与胫骨螺钉相关的刺激症状或（2）需要取出螺钉时，同时进行二次关节镜检查和取出胫骨螺钉，DB组和SB + ALL组分别有28例和23例患者在术后24.0±6.8个月和24.9±8.1个月接受了检查）。对两组间的所有测量结果进行比较。
结果
两组术后临床结果均显著改善。（所有变量均显示P <.001）两组间未发现统计学上的差异结果。此外，两组在MRI及二次关节镜检查中的术后移植物连续性无差异。
结论
DB组和SB + ALL组术后临床、影像学及二次关节镜检查结果相似。与术前测量结果相比，两组术后均显示出良好的稳定性和临床结果。
证据级别
II级，随机对照试验。
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