Simard Sebastien G, Greenfield Christina J, Khoury Anthony N
Clinique Chirurgicale de Laval, Laval, Québec, Canada.
Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Québec, Canada.
Arthroscopy. 2024 Jul 26. doi: 10.1016/j.arthro.2024.07.021.
To compare the postoperative side-to-side laxity and short-term clinical outcomes of patients who received primary anterior cruciate ligament (ACL) repair with suture tape augmentation, acute anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation performed within 8 weeks of injury (ACLR), or ACLR beyond 8 weeks of injury.
After institutional review board approval was obtained, 100 patients were enrolled in this prospective trial: 34 primary ACL repair with suture tape augmentation, 33 ACLRs performed within 8 weeks of injury (ACLR), and 33 ACLRs. Patients were allocated to ACL repair if a proximal avulsion was present with good tissue quality (Sherman type 1), confirmed by intraoperative diagnostic arthroscopy. Preoperative side-to-side anteroposterior knee laxity was assessed with KT-1000 arthrometer, and patient-reported outcomes (PROs) including the visual analog scale, Marx activity scale, Veterans RAND 12-item health survey (VR-12 physical & mental), Single Assessment Numeric Evaluation, Knee Injury and Osteoarthritis Outcome Score survey subscales, and range of motion were collected. These objective and subjective measures were repeated at regular intervals postoperatively through 2 years. Minimal clinically important difference calculations were performed assessing postoperative PRO changes at 2 years compared with preoperative.
The average time from injury to surgery was 5.03 ± 1.2 weeks for the ACL repair group, 5.09 ± 0.74 weeks for the ACLR, and 43.22 ± 33.5 weeks for the ACLR group. Postoperatively, the KT-1000 side-to-side laxity difference for 30 lbs was determined to be 0.1 ± 0.37 (95% confidence interval [CI] -0.7 to 0.8) for ACL repair versus ACLR (P < .0001), -0.8 ± 0.35 (95% CI -1.5 to -0.1) for ACLR versus ACLR (P < .0001), and 0.8 ± 0.40 (95% CI 0.0-1.6) for ACL repair versus ACLR (P < .0001). The data reveal ACL repair and ACLR are noninferior to ACLR at 2-year follow-up. The postoperative difference from baseline for all PROs demonstrated improvement for all PROs. Magnetic resonance imaging at 1 year revealed tissue healing for the 3 ACL injury treatment groups.
Patients who underwent ACL repair of proximal tears with suture tape augmentation or ACL reconstruction within 8 weeks from injury resulted in noninferior side-to-side knee laxity, comparable PROs, and similar range of motion at 2-year follow-up compared with ACLR.
Level II, prospective comparative study.
比较接受初次前交叉韧带（ACL）缝合带增强修复术的患者、在损伤后8周内进行急性前交叉韧带重建术（ACLR）并使用缝合带增强的患者，以及在损伤8周后进行ACLR的患者术后的侧方松弛度和短期临床疗效。
在获得机构审查委员会批准后，100例患者纳入了这项前瞻性试验：34例接受初次ACL缝合带增强修复术，33例在损伤后8周内进行ACLR（早期ACLR），33例在损伤8周后进行ACLR。如果术中诊断性关节镜检查证实存在近端撕脱且组织质量良好（谢尔曼1型），则将患者分配至ACL修复组。术前使用KT-1000关节测量仪评估膝关节前后侧方松弛度，并收集患者报告的结局（PROs），包括视觉模拟量表、马克思活动量表、退伍军人兰德12项健康调查（VR-12身体和精神）、单项评估数字评价、膝关节损伤和骨关节炎结局评分调查子量表以及活动范围。术后定期重复这些客观和主观测量，持续2年。计算最小临床重要差异，评估术后2年与术前相比PROs的变化。
ACL修复组从损伤到手术的平均时间为5.03±1.2周，早期ACLR组为5.09±0.74周，晚期ACLR组为43.22±33.5周。术后，对于30磅的力，ACL修复与早期ACLR相比，KT-1000测量的侧方松弛度差异为0.1±0.37（95%置信区间[CI]-0.7至0.8）（P<0.0001）；早期ACLR与晚期ACLR相比为-0.8±0.35（95%CI-1.5至-0.1）（P<0.0001）；ACL修复与晚期ACLR相比为0.8±0.40（95%CI0.0-1.6）（P<0.0001）。数据显示，在2年随访时，ACL修复和早期ACLR不劣于晚期ACLR。所有PROs术后与基线的差异均显示所有PROs均有改善。术后1年的磁共振成像显示3个ACL损伤治疗组均有组织愈合。
与晚期ACLR相比，接受近端撕裂的ACL缝合带增强修复术或在损伤后8周内进行ACL重建术的患者，在2年随访时膝关节侧方松弛度不劣、PROs相当且活动范围相似。
II级，前瞻性比较研究。
