延迟前交叉韧带重建与内侧半月板撕裂的发生率增加有关。
Delaying ACL reconstruction is associated with increased rates of medial meniscal tear.
机构信息
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de La Croix Rousse, 69004, Lyon, France.
Sydney Orthopaedic Research Institute, University of Notre Dame Australia, Hornsby and Ku-Ring Hospital, Sydney, Australia.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4458-4466. doi: 10.1007/s00167-023-07516-7. Epub 2023 Jul 24.
PURPOSE
The aim of this study was to evaluate the relationship between the time from injury to ACL reconstruction (ACLR) and the rate as well as repairability of meniscal tears. Secondary aims were to evaluate the relationship between meniscal injury and Tegner Activity Scale, age, BMI, and gender.
METHODS
Between 2012 and 2022, 1,840 consecutive ACLRs were performed. A total of 1,317 ACLRs were included with a mean patient age of 31.2 years ± 10.5 [16-60]. Meniscal tear was assessed during arthroscopy using the ISAKOS classification. Time from injury to ACLR, Tegner Activity Scale, age, BMI and gender were analysed in uni- and then in multivariate analyses. Patients were divided into four groups according to the time from injury to surgery: < 3 months (427; 32%), 3-6 months (388; 29%), 6-12 months (248; 19%) and > 12 months (254; 19%).
RESULTS
Delaying ACLR > 12 months significantly increased the rate of medial meniscal (MM) injury (OR 1.14; p < 0.001). No correlation was found between a 3- or 6-month time from injury to surgery and MM tear. Performing ACLR > 3, 6, or 12 months after injury did not significantly increase the rate of lateral meniscal (LM) injury. Increasing Tegner activity scale was significantly associated with a lower rate of MM injury (OR 0.90; p = 0.020). An age > 30 years (OR 1.07; p = 0.025) and male gender (OR 1.13; p < 0.0001) was also associated with an increased rate of MM injury. Age > 30 years decreased the rate of MM repair (OR 0.85; p < 0.001). Male gender increased the rate of LM tear (OR 1.10; p = 0.001).
CONCLUSION
Performing ACLR more than 12 months after injury was associated with increased rates of MM injury but not with lower rates of repairable lesions. An increased pre-injury Tegner activity score was associated with a decreased rate of MM tear. Age > 30 years was associated with an increased rate of MM tear with concomitant ACL injury and a decreased rate of repairability of MM tear. ACLR should be performed within 12 months from injury to prevent from the risk of MM injury.
LEVEL OF EVIDENCE
Level III.
目的
本研究旨在评估 ACL 重建（ACLR）与半月板撕裂的发生率和可修复性之间的时间关系。次要目的是评估半月板损伤与 Tegner 活动量表、年龄、BMI 和性别之间的关系。
方法
2012 年至 2022 年间，共进行了 1840 例连续 ACLR。共纳入 1317 例 ACLR，患者平均年龄 31.2±10.5 岁（16-60 岁）。在关节镜下使用 ISAKOS 分类评估半月板撕裂。分析受伤至 ACLR 的时间、Tegner 活动量表、年龄、BMI 和性别，并进行单因素和多因素分析。根据受伤至手术的时间将患者分为四组：<3 个月（427 例；32%）、3-6 个月（388 例；29%）、6-12 个月（248 例；19%）和>12 个月（254 例；19%）。
结果
ACL 重建延迟>12 个月显著增加内侧半月板（MM）损伤的发生率（OR 1.14；p<0.001）。3 个月或 6 个月的受伤至手术时间与 MM 撕裂无相关性。ACL 重建>3、6 或 12 个月后，外侧半月板（LM）损伤的发生率并未显著增加。Tegner 活动量表的增加与 MM 损伤的发生率降低显著相关（OR 0.90；p=0.020）。年龄>30 岁（OR 1.07；p=0.025）和男性（OR 1.13；p<0.0001）也与 MM 损伤的发生率增加相关。年龄>30 岁降低了 MM 修复的可能性（OR 0.85；p<0.001）。男性增加了 LM 撕裂的发生率（OR 1.10；p=0.001）。
结论
受伤后 12 个月以上进行 ACLR 与 MM 损伤发生率增加有关，但与可修复性损伤发生率降低无关。受伤前 Tegner 活动评分增加与 MM 撕裂发生率降低有关。年龄>30 岁与 ACL 合并 MM 撕裂的发生率增加和 MM 撕裂可修复性降低有关。ACL 重建应在受伤后 12 个月内进行，以预防 MM 损伤的风险。
证据等级
III 级。
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