Lavoie-Gagne Ophelie, Nukala Varun, Berkson Eric M, Asnis Peter, Price Mark D, Oh Luke S, Tanaka Miho J
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Jan 8;6(1):100843. doi: 10.1016/j.asmr.2023.100843. eCollection 2024 Feb.
To investigate the relation between hemoglobin A1c (HbA1c) levels and postoperative complications after primary anterior cruciate ligament reconstruction (ACLR).
A retrospective review was performed of consecutive patients with an isolated anterior cruciate ligament tear, preoperative diagnosis of diabetes, and documented HbA1c within 90 days of primary ACLR between 2000 and 2019. Data collected included demographic and surgical characteristics, 90-day medical complications, and subsequent surgeries on the ipsilateral knee. A receiver operating curve was constructed for each HbA1c level in relation to postoperative complications and the optimal cutoff identified via Youden's statistic. Multivariable logistic regression was performed to assess the relation between postoperative complications and age, sex, graft type, diabetes subtype, and HbA1c.
Nineteen patients (7 females, 12 males) fulfilled inclusion criteria with preoperative HbA1c ranging from 5.5 to 10. Complications included septic knee (n = 1) and cyclops lesions requiring arthroscopic lysis (n = 3). Patients with HbA1c of 6.7% or higher were 25 times more likely to experience any postoperative complication ( = .04) and 16 times more likely to require lysis of adhesions ( = .08). On multivariable regression, HbA1c remained significantly associated with any complication ( = .005) and developing arthrofibrosis ( = .02) independent of age, sex, graft type, and diabetes subtype.
Diabetic patients undergoing primary ACLR with a preoperative HbA1c of 6.7% or higher were 25 times more likely to require repeat surgical intervention for a postoperative complication. These complications included arthrofibrosis and infection. Strict glycemic control may help minimize the risk of postoperative complications after ACLR.
Level III, retrospective cohort study.
探讨初次前交叉韧带重建术（ACLR）后糖化血红蛋白（HbA1c）水平与术后并发症之间的关系。
对2000年至2019年间连续收治的单纯前交叉韧带撕裂、术前诊断为糖尿病且初次ACLR术后90天内有HbA1c记录的患者进行回顾性研究。收集的数据包括人口统计学和手术特征、90天内的医疗并发症以及同侧膝关节随后的手术情况。针对每个HbA1c水平构建与术后并发症相关的受试者工作特征曲线，并通过约登指数确定最佳截断值。进行多变量逻辑回归分析，以评估术后并发症与年龄、性别、移植物类型、糖尿病亚型和HbA1c之间的关系。
19例患者（7例女性，12例男性）符合纳入标准，术前HbA1c范围为5.5至10。并发症包括膝关节感染（n = 1）和需要关节镜松解的独眼病变（n = 3）。HbA1c水平为6.7%或更高的患者发生任何术后并发症的可能性高25倍（P = 0.04），需要粘连松解的可能性高16倍（P = 0.08）。在多变量回归分析中，独立于年龄、性别、移植物类型和糖尿病亚型，HbA1c仍与任何并发症（P = 0.005）和发生关节纤维化（P = 0.02）显著相关。
术前HbA1c水平为6.7%或更高的糖尿病患者因术后并发症需要再次手术干预的可能性高25倍。这些并发症包括关节纤维化和感染。严格的血糖控制可能有助于降低ACLR术后并发症的风险。
III级，回顾性队列研究。
