Department of Orthopaedic Surgery, Columbia Orthopaedic Group, Columbia, Missouri.
Department of Orthopaedic Surgery, University of Missouri-Columbia, Columbia, Missouri.
J Knee Surg. 2024 Apr;37(5):381-390. doi: 10.1055/a-2129-8893. Epub 2023 Jul 14.
Anterior cruciate ligament reconstruction (ACLR) using suture tape augmentation to internally brace is a relatively new technique. The primary goal of this study was to prospectively collect patient-reported outcomes (PROs) and surgical history from patients who underwent primary ACLR with internal bracing to determine if internal bracing resulted in a low graft failure rate while maintaining acceptable PROs. A total of 252 patients with a mean age of 23.6 years (95% confidence interval [CI]: 22.1-25.1) and a mean follow-up of 37.9 months (95% CI: 35.8-40.0) were included in this study. Patients who underwent primary ACLR with internal brace augmentation between July 12, 2016 and July 31, 2021 were eligible. A total of 222 patients were contacted via telephone and administered the visual analog scale (VAS), the single assessment numeric evaluation (SANE), the Lysholm knee score scale, and, if applicable, the short version ACL return to sport after injury (SV-ACL-RSI) survey. Additionally, patients were asked to give an updated orthopaedic history. Thirty additional patients were included from either our institution's registry or by completing their surveys in-office or by e-mail. The minimal clinically important difference (MCID) and patient-acceptable symptom states (PASS) were calculated based on our patient population and applied to each individual patient. The patients' electronic health record (EHR) was searched for pre- and postoperative clinical data including KT-1000 arthrometer measurements. Two patients (0.8%) had subsequent graft failures and one patient (0.4%) required a revision surgery. MCID was achieved in 242 patients (96.0%) for the Lysholm, 227 patients (90.1%) for the SANE, and 146 patients (57.9%) for the VAS. PASS was achieved in 214 patients (84.9%) for the Lysholm, 198 patients (78.6%) for the SANE, and 199 (80.0%) patients for the VAS, postoperatively. Of note, 65 patients (25.8%) exceeded the PASS threshold for the VAS preoperatively. A total of 127 patients (84.4%) met the cutoff of ≥60/100 for the SV-ACL-RSI survey postoperatively. Postoperative KT-1000 measurements showed near-identical side-to-side differences at both the 13.6-kg pull and manual maximum pull. When stratifying patients based on age at the time of surgery, it was noted that patients younger than 25 years had significantly higher SANE scores (91.6 [95% CI: 90.2-92.9] vs. 82.6 [95% CI: 79.0-86.2]; < 0.0001) and lower VAS pain scores (0.7 [95% CI: 0.5-0.8] vs. 1.2 [95% CI: 0.8-1.5]; = 0.004). Primary ACLR with internal bracing led to acceptable patient outcomes and a graft failure rate of less than 1%. LEVEL OF EVIDENCE:: case series, IV.
前交叉韧带重建（ACLR）使用缝线带增强内部支撑是一种相对较新的技术。本研究的主要目的是前瞻性收集接受 ACLR 内部支撑的患者的患者报告结局（PROs）和手术史，以确定内部支撑是否在保持可接受的 PROs 的同时降低移植物失败率。共有 252 名平均年龄 23.6 岁（95%置信区间[CI]：22.1-25.1）、平均随访 37.9 个月（95%CI：35.8-40.0）的患者纳入本研究。本研究纳入了 2016 年 7 月 12 日至 2021 年 7 月 31 日期间接受 ACLR 内部支撑增强的患者。共通过电话联系了 222 名患者，并对其进行了视觉模拟量表（VAS）、单项评估数字评估（SANE）、Lysholm 膝关节评分量表以及（如适用）短版 ACL 损伤后重返运动（SV-ACL-RSI）调查。此外，还询问了患者最新的骨科病史。另外还从我们机构的登记处或通过在办公室或通过电子邮件完成调查，纳入了 30 名额外的患者。根据我们的患者人群计算了最小临床重要差异（MCID）和可接受症状状态（PASS），并将其应用于每位患者。患者的电子健康记录（EHR）用于搜索术前和术后的临床数据，包括 KT-1000 关节测量仪测量值。两名患者（0.8%）发生了后续移植物失败，一名患者（0.4%）需要进行翻修手术。242 名患者（96.0%）达到 Lysholm 评分的 MCID，227 名患者（90.1%）达到 SANE 评分的 MCID，146 名患者（57.9%）达到 VAS 评分的 MCID。214 名患者（84.9%）达到 Lysholm 评分的 PASS，198 名患者（78.6%）达到 SANE 评分的 PASS，199 名患者（80.0%）达到 VAS 评分的 PASS，术后。值得注意的是，65 名患者（25.8%）术前 VAS 评分超过 PASS 阈值。127 名患者（84.4%）术后满足 SV-ACL-RSI 调查≥60/100 的截止值。术后 KT-1000 测量显示在 13.6kg 拉力和手动最大拉力时，双侧差异几乎相同。当根据手术时的年龄对患者进行分层时，发现年龄小于 25 岁的患者 SANE 评分显著更高（91.6 [95% CI：90.2-92.9] vs. 82.6 [95% CI：79.0-86.2]； < 0.0001），VAS 疼痛评分更低（0.7 [95% CI：0.5-0.8] vs. 1.2 [95% CI：0.8-1.5]； = 0.004）。ACL 内部支撑的主要重建导致可接受的患者结局和低于 1%的移植物失败率。证据水平：病例系列，IV。
