Schneider Kristian Nikolaus, Theil Christoph, Gosheger Georg, Weller Jan Frederic, Goth Anna, Ahlbaeumer Georg
Department of Orthopaedics and Trauma Surgery, Klinik Gut, St. Moritz, Switzerland.
Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, Germany.
Orthop J Sports Med. 2024 May 30;12(5):23259671241244734. doi: 10.1177/23259671241244734. eCollection 2024 May.
Recent studies have suggested promising patient-reported outcomes after primary anterior cruciate ligament (ACL) repair with additional suture augmentation (SA).
To evaluate the risk for revision surgery and identify patient- and injury-related risk factors after ACL repair with SA in a large patient cohort subject to strict patient selection.
Case-control study; Level of evidence, 3.
Included were 86 patients (61 female; 93% follow-up rate) who underwent arthroscopic ACL repair with SA between January 2017 and March 2019 by a single surgeon and had a minimum follow-up of 24 months. Patients were selected for surgery with regard to time to surgery (preferably on the day of injury), tear pattern (limited to Sherman types 1 and 2), and tissue quality (intact synovial coverage). Postoperatively, the patients who needed revision surgery were identified and compared with patients who did not undergo revision surgery, using the Mann-Whitney test for nonparametric analysis and the Student test for parametric analysis. A Kaplan-Meier analysis was performed to investigate the survival rate of the ACL repair.
A total of 9 patients (10%; median age, 48 years; interquartile range [IQR], 27-50 years) underwent revision surgery at 12 months postoperatively (IQR, 8-25 months). The median follow-up of patients without revision surgery was 35 months (IQR, 33-44 months). The revision-free survival rate was 97% (95% CI, 93%-100%) after 1 year, 93% (95% CI, 88%-98%) after 2 years, and 90% (95% CI, 83%-97%) after 4 years. Patient-related factors-such as sex ( = .98), age at surgery ( = .459), body mass index ( = .352), and preinjury level of sports ( = .53)-had no significant impact on the survival rate of the ACL repair. Injury-related factors-such as concomitant injuries of the medial ( = .860) and lateral menisci ( = .414) and the medial ( = .801) and lateral collateral ligaments ( = .534) or same-day surgery compared with a delay of surgery of up to 18 days ( = .277)-had no significant impact on the survival rate of the ACL repair.
The revision rate of primary ACL repair with SA at a 2-year follow-up was 10%. Patient- and injury-related factors were not associated with the survival rate of the ACL repair.
近期研究表明，在初次前交叉韧带（ACL）修复术中附加缝线增强（SA）后，患者报告的预后前景良好。
在严格进行患者选择的大型患者队列中，评估ACL修复术附加SA后的翻修手术风险，并确定与患者和损伤相关的风险因素。
病例对照研究；证据等级，3级。
纳入2017年1月至2019年3月间由同一位外科医生进行关节镜下ACL修复术附加SA的86例患者（61例女性；随访率93%），且至少随访24个月。根据手术时间（最好在受伤当天）、撕裂类型（限于谢尔曼1型和2型）和组织质量（滑膜覆盖完整）选择手术患者。术后，确定需要翻修手术的患者，并与未进行翻修手术的患者进行比较，使用曼-惠特尼检验进行非参数分析，使用学生检验进行参数分析。进行Kaplan-Meier分析以研究ACL修复术的生存率。
共有9例患者（10%；中位年龄48岁；四分位间距[IQR]，27 - 50岁）在术后12个月（IQR，8 - 25个月）接受了翻修手术。未进行翻修手术患者的中位随访时间为35个月（IQR，33 - 44个月）。1年后无翻修生存率为97%（95%CI，93% - 100%），2年后为93%（95%CI，88% - 98%），4年后为90%（95%CI，83% - 97%）。与患者相关的因素，如性别（P = 0.98）、手术年龄（P = 0.459）、体重指数（P = 0.352）和伤前运动水平（P = 0.53），对ACL修复术的生存率无显著影响。与损伤相关的因素，如内侧（P = 0.860）和外侧半月板（P = 0.414）以及内侧（P = 0.801）和外侧副韧带（P = 0.534）的合并损伤，或与手术延迟长达18天相比同日手术（P = 0.277），对ACL修复术的生存率无显著影响。
2年随访时，初次ACL修复术附加SA的翻修率为10%。与患者和损伤相关的因素与ACL修复术的生存率无关。
