Rilk Sebastian, Goodhart Gabriel C, O'Brien Robert, DiFelice Gregory S
Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.; Medical University of Vienna, Vienna, Austria.
Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, New York, U.S.A.
Arthroscopy. 2024 Dec;40(12):2862-2871.e2. doi: 10.1016/j.arthro.2023.11.033. Epub 2024 Jan 23.
To intraoperatively evaluate the ability of anterior cruciate ligament (ACL) primary repair (ACLPR) to restore anterior tibial translation (ATT) at time zero and to assess the influence of additional suture augmentation (SA) on ATT.
Patients with proximal ACL tears undergoing arthroscopic ACLPR with dual-suture anchor fixation were included in this time-zero clinical study. Laxity measurements were taken with a digital arthrometer to evaluate ATT stability preoperatively in the office (T0) as a standardized diagnostic tool, preoperatively under anesthesia (T1), at time zero intraoperatively after ACLPR but prior to SA fixation (T2), and after SA fixation (T3).
A total of 27 patients (mean age ± standard deviation [SD], 35.1 ± 12.0 years) with proximal ACL tears and significant preoperative (T0) ATT side-to-side differences (SSDs) (mean ± SD, 4.1 ± 1.5 mm) were evaluated. ACLPR was shown to restore ATT SSD at time zero (mean ± SD, 0.2 ± 1.1 mm) given that a significant reduction in ATT SSD (mean difference ± standard error, -4.7 ± 0.21 mm; P < .001) was achieved when comparing preoperative and intraoperative measurements after separate refixation of both ACL bundles with suture anchors. Additional SA fixation did not further decrease ATT when comparing measurements of the ipsilateral leg after ACL refixation and after SA fixation (mean difference ± SD, 0.03 ± 0.22 mm; P = .496).
ACLPR with dual-suture anchor fixation restores time-zero ATT laxity in adults with proximal ACL tears. Additional SA fixation in full knee extension does not further decrease ATT.
This study provides important information about the effectiveness of ACLPR in restoring ATT. SA with the knee fixed in full knee extension does not further decrease ATT; therefore, augmentation may not lead to overconstraint of the knee or stress shielding of the repaired ACL.
术中评估前交叉韧带（ACL）初次修复（ACLPR）在零时间恢复胫骨前移（ATT）的能力，并评估额外缝线增强（SA）对 ATT 的影响。
本时间零临床研究纳入了接受关节镜下 ACLPR 双缝线锚定固定的近端 ACL 撕裂患者。使用数字关节计测量松弛度，以评估术前办公室内 ATT 稳定性（T0）作为标准化诊断工具，术前麻醉下（T1），ACLPR 后零时间但在 SA 固定之前（T2），以及 SA 固定后（T3）。
共评估了 27 例（平均年龄 ±标准差[SD]，35.1 ±12.0 岁）有近端 ACL 撕裂和术前（T0）ATT 侧别差异（SSD）显著的患者（平均 ± SD，4.1 ±1.5mm）。ACLPR 在零时间恢复 ATT SSD（平均 ± SD，0.2 ±1.1mm），因为在单独用缝线锚重新固定 ACL 束后，术前和术中测量值之间的 ATT SSD 显著减少（平均差异 ±标准误差，-4.7 ±0.21mm；P<.001）。当比较 ACL 修复后和 SA 固定后同侧肢体的测量值时，额外的 SA 固定并没有进一步降低 ATT（平均差异 ± SD，0.03 ±0.22mm；P=.496）。
双缝线锚固定 ACLPR 可恢复成人近端 ACL 撕裂患者的零时间 ATT 松弛度。在完全膝关节伸展时，额外的 SA 固定不会进一步降低 ATT。
本研究提供了 ACLPR 恢复 ATT 的有效性的重要信息。在完全膝关节伸展时，SA 固定不会进一步降低 ATT；因此，增强可能不会导致膝关节过度约束或修复的 ACL 应力遮挡。
