Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.; Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.
Arthroscopy. 2024 Apr;40(4):1247-1255. doi: 10.1016/j.arthro.2023.08.080. Epub 2023 Sep 15.
To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture.
We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport.
There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P = .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P = .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P = .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P = .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P = .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001).
Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI.
Level III, retrospective cohort study.
比较伴有和不伴有 Segond 骨折的前交叉韧带重建（ACLR）患者的临床结果、重返运动率和心理准备情况。
我们回顾性地确定了 2012 年 1 月至 2020 年 12 月期间接受初次 ACLR 治疗且随访时间至少为 2 年的患者。排除标准为有其他韧带损伤、年龄<16 岁或同时行外侧增强术。术前膝关节 X 线片用于识别 Segond 骨折。通过年龄/性别/体重指数/移植物类型对患者进行 1:2 配对以匹配对照。通过查阅病历评估术前和术后膝关节稳定性。评估的调查问卷包括受伤前的运动参与情况和恢复情况、Lysholm 评分、Tegner 活动量表和 ACL 运动准备指数（ACL-RSI），ACL-RSI 是心理运动准备的指标。采用多变量逻辑回归分析确定重返运动的预测因素。
最终纳入 120 名患者（40 名伴有 Segond 骨折，80 名对照）进行分析，平均随访 5.7±2.4 年。52.5%的患者接受了骨-髌腱-骨自体移植物。Segond 组的总体重返运动率为 79.5%，对照组为 83.8%（P=0.569）。Segond 组中有 48.7%和对照组中有 56.8%的患者恢复到受伤前的运动水平（P=0.415）。Lysholm（89.6±10.3 与 85.4±16.7，P=0.296）、Tegner（5.7±1.8 与 6.1±2.2，P=0.723）和 ACL-RSI（62.2±25.4 与 56.6±25.4，P=0.578）评分在 Segond 组和对照组之间相似。Segond 组有 1 例移植物在术后 5 年失败。ACL-RSI 评分升高与重返运动显著相关（P<0.001）。
在至少 2 年的随访中，接受单纯 ACLR 且未行外侧增强术的 ACL 撕裂伴 Segond 骨折患者的临床结果和运动恢复率与匹配的单纯 ACLR 对照组相似。通过 ACL-RSI 测量，两组之间的心理准备情况无显著差异。
III 级，回顾性队列研究。
