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在多韧带损伤膝关节中采用缝线增强技术进行内侧副韧带急性经皮修复可获得良好的稳定性且术后僵硬发生率低。

Acute Percutaneous Repair of Medial Collateral Ligament With Suture Augmentation in the Multiligamentous Injured Knee Results in Good Stability and Low Rates of Postoperative Stiffness.

作者信息

Holuba Kurt, Rilk Sebastian, Vermeijden Harmen D, O'Brien Robert, van der List Jelle P, DiFelice Gregory S

机构信息

Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, U.S.A.

Medical University of Vienna, Vienna, Austria.

出版信息

Arthrosc Sports Med Rehabil. 2023 Oct 4;5(6):100799. doi: 10.1016/j.asmr.2023.100799. eCollection 2023 Dec.

Abstract

PURPOSE

To assess the clinical and patient-reported outcome measures (PROMs) of acute superficial medial collateral ligament (sMCL) repair with suture augmentation (SA) in the setting of a multiligamentous injured knees (MLIKs) at 2-year follow-up.

METHODS

A retrospective analysis of consecutive patients with MLIK with grade III sMCL injuries who underwent acute (<6 weeks) sMCL repair with SA was conducted. Clinical follow-up was performed at minimum 1-year postoperatively, and PROMs were collected at the latest follow-up (minimum 2 years' postoperatively). Continuous variables were reported in median with interquartile range (IQR).

RESULTS

A total of 20 patients (41.4 [28.5-47.9] years of age) with grade III sMCL injury and additional injury to 1 cruciate ligament (KDI-M; n = 13) or bicruciate (KDIII-M; n = 7) were enrolled with a median follow-up of 4.3 (3.6-5.2) years. In total, 90% (n = 18) of patients with MLIK treated with acute sMCL repair and early range of motion rehabilitation protocol demonstrated negative valgus laxity stress testing in 0 and 30° flexion and low reoperation rates (n = 1, 5%) due to stiffness. In addition, good-to-excellent subjective outcomes were reported at final follow-up: median International Knee Documentation Committee 82.2 (78.7-90.8), Lysholm 95.0 (90.0-100.0), modified Cincinnati Score 89.0 (83.3-96.0), Single Assessment Numeric Evaluation 90.0 (83.8-95.0), Forgotten Joint Score 79.2 (62.5-91.7), Tegner 5.0 (IQR 4.0-6.0), and ACL-Return to Sport after Injury Scale 78.3 (IQR 66.7-90.0).

CONCLUSIONS

In this study, 20 heterogenous patients with MLIKs treated with acute percutaneous sMCL repair with SA had excellent stability, low rates of postoperative stiffness, and good-to-excellent PROMs at short-term follow-up.

LEVEL OF EVIDENCE

Level IV, therapeutic case series.

摘要

目的

评估在多韧带损伤膝关节(MLIKs)中,采用缝线增强(SA)技术进行急性浅表内侧副韧带(sMCL)修复术后2年的临床及患者报告结局指标(PROMs)。

方法

对连续的MLIK且sMCL损伤为III级并接受急性(<6周)SA技术sMCL修复的患者进行回顾性分析。术后至少1年进行临床随访,并在最近一次随访(术后至少2年)时收集PROMs。连续变量以中位数及四分位数间距(IQR)报告。

结果

共纳入20例患者(年龄41.4 [28.5 - 47.9]岁),其sMCL损伤为III级,且合并1条交叉韧带损伤(KDI - M;n = 13)或双交叉韧带损伤(KDIII - M;n = 7),中位随访时间为4.3(3.6 - 5.2)年。总体而言,90%(n = 18)接受急性sMCL修复及早期活动范围康复方案治疗的MLIK患者在0°和30°屈曲时外翻松弛应力试验为阴性,且因僵硬导致的再次手术率较低(n = 1,5%)。此外,末次随访时报告的主观结局良好至优秀:国际膝关节文献委员会评分中位数82.2(78.7 - 90.8),Lysholm评分95.0(90.0 - 100.0),改良辛辛那提评分89.0(83.3 - 96.0),单评估数字评价90.0(83.8 - 95.0),遗忘关节评分79.2(62.5 - 91.7),Tegner评分5.0(IQR 4.0 - 6.0),以及前交叉韧带损伤后恢复运动量表评分78.3(IQR 66.7 - 90.0)。

结论

在本研究中,20例采用急性经皮SA技术sMCL修复治疗的异质性MLIK患者在短期随访时具有出色的稳定性、较低的术后僵硬发生率及良好至优秀的PROMs。

证据水平

IV级,治疗性病例系列。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e9e6/10562670/27243f672a6f/gr1.jpg

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