Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
Department of Biomedical Engineering, University of Basel, Basel, Switzerland.
Am J Sports Med. 2023 Oct;51(12):3131-3141. doi: 10.1177/03635465231194784. Epub 2023 Sep 7.
Recently, interest in anterior cruciate ligament (ACL) preservation and repair after proximal ACL tears has been resurrected. Although good clinical outcomes have been reported in the literature with adequate patient selection, to date detailed scientific evidence for the functional benefit of primary ACL repair with ligament augmentation is scarce.
To compare patient-reported, clinical, and functional outcomes in patients 2 years after ACL repair and InternalBrace augmentation (ACL-IB) with age- and sex-matched patients 2 years after ACL reconstruction (ACL-R) and with matched healthy controls.
Cohort study; Level of evidence, 3.
In total, 29 patients 2 years after ACL-IB, 27 sex- and age- matched patients 2 years after ACL-R (hamstring autografts), and 29 matched healthy controls were included. Patient-reported outcomes were assessed using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, EQ-5D-5L, Tegner Activity Scale, and Anterior Cruciate Ligament Return to Sports after Injury scale. Surgery time was recorded. For clinical outcomes, range of motion and thigh and shank circumference were measured, and passive anterior translation was determined using the Rolimeter. Isokinetic muscle strength was measured using a Biodex dynamometer. The limb symmetry index (operated/contralateral or nondominant/dominant × 100), side-to-side differences (operated - contralateral, nondominant - dominant), and hamstring-quadriceps ratios were calculated for functional parameters. Failure and reoperation rates were not compared.
Two years after surgery, patients treated with ACL-IB showed good to excellent patient-reported outcomes comparable with those of patients after ACL-R. Surgery time, including concomitant surgeries, was significantly shorter in the ACL-IB group (mean, 81 minutes) compared with the ACL-R group (mean, 97 minutes) ( = .024). Isokinetic muscle strength was comparable between patient groups without significant differences in extensor and flexor strength or in hamstring-quadriceps ratios.
These results suggest that ACL-IB achieves comparable patient-reported, clinical, and functional outcomes with ACL-R at 2 years postoperatively and, after careful patient selection, should be considered as a valuable early treatment alternative for proximal ACL tears.
NCT04429165 (ClinicalTrials.gov identifier).
最近，人们对前交叉韧带（ACL）损伤后近端 ACL 保留和修复产生了兴趣。尽管在适当的患者选择下，文献中报道了良好的临床结果，但迄今为止，关于 ACL 修复联合韧带增强术治疗原发性 ACL 修复的功能获益的详细科学证据仍然很少。
比较 ACL 修复联合 InternalBrace 增强术（ACL-IB）后 2 年的患者、ACL 重建（ACL-R）后 2 年的年龄和性别匹配患者以及匹配的健康对照组的患者报告结局、临床和功能结局。
队列研究；证据水平，3 级。
共纳入 29 例 ACL-IB 后 2 年、27 例 ACL-R（自体腘绳肌腱）后 2 年且年龄和性别匹配的患者和 29 例匹配的健康对照组。采用国际膝关节文献委员会评分、膝关节损伤和骨关节炎结果评分、EQ-5D-5L、Tegner 活动量表和前交叉韧带损伤后重返运动量表评估患者报告结局。记录手术时间。为评估临床结局，测量膝关节活动度、大腿和小腿周径，并使用 Rolimeter 测定被动前向胫骨平移。使用 Biodex 测力计测量等速肌力。计算功能参数的肢体对称性指数（患侧/对侧或非优势侧/优势侧×100）、侧间差异（患侧-对侧、非优势侧-优势侧）和股四头肌/腘绳肌比值。未比较失败和再次手术率。
手术后 2 年，ACL-IB 治疗的患者报告结局良好至优秀，与 ACL-R 患者相当。包括同时进行的手术在内，ACL-IB 组的手术时间（平均 81 分钟）明显短于 ACL-R 组（平均 97 分钟）（ =.024）。患者组之间的等速肌力无显著差异，伸肌和屈肌力量或股四头肌/腘绳肌比值均无显著差异。
这些结果表明，ACL-IB 在术后 2 年时可获得与 ACL-R 相当的患者报告结局、临床和功能结局，且在进行仔细的患者选择后，可作为治疗近端 ACL 撕裂的一种有价值的早期治疗选择。
NCT04429165（ClinicalTrials.gov 标识符）。
