Lee Dhong Won, Lee Dong Hwan, Cho Seung Ik, Yang Sang Jin, Kim Woo Jong, Lee Joon Kyu, Kim Jin Goo
Department of Orthopaedic Surgery, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Sports Medical Center, KonKuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea.
Orthop J Sports Med. 2023 Sep 26;11(9):23259671231178048. doi: 10.1177/23259671231178048. eCollection 2023 Sep.
Inferior return to sports (RTS) and functional outcomes have been reported in women after anterior cruciate ligament reconstruction (ACLR).
PURPOSE/HYPOTHESIS: The purpose was to evaluate the results of combined ACLR and anterolateral ligament reconstruction (ALLR) in young women with a high-grade pivot shift (grade ≥2). It was hypothesized that combined ACLR and ALLR would result in better RTS and rotational stability than isolated ACLR.
Cohort study; Level of evidence, 3.
Two groups were retrospectively evaluated and compared. Group I (n = 39; mean age, 31.1 ± 5.7 years) underwent isolated ACLR using hamstring autografts; group C (n = 39; mean age, 30.4 ± 6.1 years) underwent combined ACLR and ALLR. Subjective outcome measures included the International Knee Documentation Committee subjective form, Lysholm, Tegner, and ACL-Return to Sport after Injury (ACL-RSI). Objective tests included a KT-2000 arthrometer stress test, a pivot-shift test, an isokinetic strength test, a Y-balance test, and a single-leg hop test. A postoperative questionnaire was administered to determine the rates and types of RTS, quality of sports performance, and reinjury and satisfaction rates. Subjective scores and clinical tests were performed at 2 years. Magnetic resonance imaging and second-look arthroscopy were conducted during the 1- and 2-year follow-ups, respectively.
The mean follow-up for groups I and C were 30.4 ± 3.9 and 29.3 ± 3.5 months, respectively ( = .194). Patients in group C had better anteroposterior ( = .001) and rotational ( = .005) stability and higher ACL-RSI scores ( = .025) than those in group I. Group C had higher composite and posteromedial reach scores on the Y-balance test than group I ( = .014 and = .010, respectively). A total of 26 (66.7%) patients in group C and 17 (43.6%) in group I returned to their prior level of sports ( = .040). Rerupture of the ACL graft and contralateral ACL rupture occurred in 2 (5.1%) and 2 (5.1%) patients in group I, respectively, compared with no rerupture or contralateral ACL rupture in group C.
Combined ACLR and ALLR in young women with a high-grade pivot shift was associated with better knee stability parameters, dynamic postural stability, and psychological readiness to RTS than isolated ACLR.
据报道，女性前交叉韧带重建（ACLR）术后运动恢复（RTS）情况较差且功能预后不佳。
目的/假设：本研究旨在评估联合前交叉韧带重建（ACLR）与前外侧韧带重建（ALLR）对伴有高级别轴移（≥2级）的年轻女性的治疗效果。研究假设为，相较于单纯ACLR，联合ACLR与ALLR能带来更好的RTS及旋转稳定性。
队列研究；证据等级为3级。
对两组患者进行回顾性评估与比较。第一组（n = 39；平均年龄31.1±5.7岁）采用自体腘绳肌腱进行单纯ACLR；C组（n = 39；平均年龄30.4±6.1岁）接受ACLR联合ALLR。主观预后指标包括国际膝关节文献委员会主观量表、Lysholm量表、Tegner量表以及损伤后ACL-运动恢复（ACL-RSI）。客观测试包括KT-2000关节测量仪应力测试、轴移试验、等速肌力测试、Y平衡测试以及单腿跳测试。通过术后问卷调查确定RTS的发生率及类型、运动表现质量、再损伤率及满意度。在术后2年进行主观评分及临床测试。在1年和2年随访期间分别进行磁共振成像及二次关节镜检查。
第一组和C组的平均随访时间分别为30.4±3.9个月和29.3±3.5个月（P = 0.194）。C组患者在前后向（P = 0.001）和旋转（P = 0.005）稳定性方面均优于第一组，且ACL-RSI评分更高（P = 0.025）。在Y平衡测试中，C组的综合及后内侧伸展评分均高于第一组（分别为P = 0.014和P = 0.010）。C组共有26例（66.7%）患者恢复到之前的运动水平，第一组为17例（43.6%）（P = 0.040）。第一组有2例（5.1%）患者出现ACL移植物再断裂，2例（5.1%）出现对侧ACL断裂，而C组未出现再断裂或对侧ACL断裂情况。
对于伴有高级别轴移的年轻女性，联合ACLR与ALLR相较于单纯ACLR，在膝关节稳定性参数、动态姿势稳定性以及RTS心理准备方面表现更佳。
Zotero 插件
