Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France.
University of Rome La Sapienza, Orthopaedics and Traumatology Rome, Lazio, Italy.
Am J Sports Med. 2024 Jun;52(7):1765-1772. doi: 10.1177/03635465241247760. Epub 2024 May 25.
Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament (ACL) reconstruction (ACLR) and lateral extra-articular procedures (LEAPs) over isolated ACLR in terms of reducing graft rupture and reoperation rates. However, most of the published studies have included young patients, and no studies have focused on patients aged >30 years.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare the outcomes of isolated ACLR versus ACLR + LEAP at midterm follow-up in patients aged >30 years. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture.
Cohort study; Level of evidence, 3.
Patients >30 years of age who underwent primary ACLR + LEAP between January 2003 and December 2020 were propensity matched at a 1:1 ratio to patients who underwent isolated ACLR. A retrospective analysis of prospectively collected data was performed to determine graft rupture rates, knee stability, reoperation rates, and complications. Graft survivorship was assessed using the Kaplan-Meier method. Risk factors associated with the occurrence of graft failure were analyzed using a Cox proportional hazards model.
Two groups of 551 patients each were included in the study, and the mean follow-up was 97.19 ± 47.23 months. The overall mean age was 37.01 ± 6.24 years. The LEAP group consisted of 503 (91.3%) patients who had anterolateral ligament reconstruction and 48 (8.7%) patients who had a Lemaire procedure. Overall, 19 (1.7%) patients had graft failure: 15 (2.7%) in the no-LEAP group and 4 (0.7%) in the LEAP group ( = .0116). The risk of graft failure was significantly associated with the absence of LEAP (31 vs 12; hazard ratio, 3.309; 95% CI, 1.088-10.065; = .0350) and age between 30 and 35 years (hazard ratio, 4.533; 95% CI, 1.484-13.841; = .0080). A higher rate of reoperation for secondary meniscectomy was found in the no-LEAP group (5.6% vs 2.2%; = .0031).
Patients aged >30 years who underwent combined ACLR and LEAP experienced a >3-fold lower risk of ACL graft failure compared with those who underwent isolated ACLR. Furthermore, the group without LEAP experienced a higher rate of secondary meniscectomy.
临床研究表明，与单独前交叉韧带 (ACL) 重建 (ACLR) 相比，联合 ACLR 和外侧关节外手术 (LEAPs) 在降低移植物破裂和再次手术率方面具有显著优势。然而，大多数已发表的研究都纳入了年轻患者，没有研究关注年龄>30 岁的患者。
目的/假设：本研究旨在比较年龄>30 岁的患者在中期随访时单独进行 ACLR 与 ACLR+LEAP 的结果。假设是接受联合手术的患者移植物破裂率会显著降低。
队列研究；证据水平，3 级。
对 2003 年 1 月至 2020 年 12 月期间接受 ACLR+LEAP 的年龄>30 岁的患者进行倾向评分匹配，以 1:1 的比例与接受单独 ACLR 的患者进行匹配。对前瞻性收集的数据进行回顾性分析，以确定移植物破裂率、膝关节稳定性、再次手术率和并发症。使用 Kaplan-Meier 方法评估移植物存活率。使用 Cox 比例风险模型分析与移植物失败发生相关的风险因素。
研究纳入了两组各 551 例患者，平均随访时间为 97.19±47.23 个月。平均年龄为 37.01±6.24 岁。LEAP 组包括 503 例（91.3%）前外侧韧带重建患者和 48 例（8.7%）Lemaire 手术患者。总的来说，有 19 例（1.7%）患者发生移植物失败：无 LEAP 组 15 例（2.7%），LEAP 组 4 例（0.7%）（ =.0116）。移植物失败的风险与无 LEAP（31 例与 12 例；风险比，3.309；95%CI，1.088-10.065； =.0350）和 30-35 岁年龄（风险比，4.533；95%CI，1.484-13.841； =.0080）显著相关。无 LEAP 组的二次半月板切除术再手术率较高（5.6%比 2.2%； =.0031）。
与单独 ACLR 相比，年龄>30 岁接受 ACLR 和 LEAP 联合治疗的患者 ACL 移植物失败的风险降低了>3 倍。此外，无 LEAP 的组发生二次半月板切除术的几率更高。
