与接受前交叉韧带重建的患者相比，在旋转运动中受伤并接受多韧带膝关节重建的患者在术后2年时的临床、功能及恢复运动情况相似。
Patients undergoing multiligament knee reconstruction injured during pivoting sports demonstrate similar clinical, functional and return to sport outcomes by 2 years compared with those undergoing anterior cruciate ligament reconstruction.
作者信息
Ebert Jay R, Edwards Peter K, Mayne Alistair I W, Davies Peter S E, Evans Robert, Aujla Randeep S, Malik Shahbaz S, Dalgleish Stephen, Gohil Satyen, D'Alessandro Peter
机构信息
School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia.
HFRC Rehabilitation Clinic, Perth, Western Australia, Australia.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2025 Mar;33(3):865-877. doi: 10.1002/ksa.12409. Epub 2024 Aug 5.
PURPOSE
This study investigates the clinical and activity-based outcomes after anterior cruciate ligament reconstruction (ACLR) versus multiligamentous knee reconstruction (MLKR) following a pivoting sports injury.
METHODS
Fifty MLKR patients were included, of which 20 (40%) were injured during pivoting sports. A further 50 patients undergoing ACLR following an injury during pivoting sports were consecutively recruited for comparison. Patients were assessed before the surgery and at 6-, 12- and 24 months with patient-reported outcome measures (PROMs) including the International Knee Documentation Committee (IKDC) form, Tegner activity scale (TAS) and anterior cruciate ligament return to sport after injury (ACL-RSI) score. Knee movement, the single (SHD) and triple (THD) hop tests for distance, and peak isokinetic knee extensor and flexor strength were assessed, with Limb Symmetry Indices (LSIs) calculated. Outcomes were compared across groups: (1) ACLR (n = 50), (2) MLKR (n = 50) and (3) MLKR due to pivoting sport injury (n = 20).
RESULTS
IKDC, TAS and ACL-RSI scores remained lower (p < 0.05) in the full MLKR versus ACLR cohort at all timepoints. Comparing the ACLR and MLKR cohort that had injuries specifically during pivoting sports, the IKDC (p < 0.001) and TAS (p = 0.009) were higher in the ACLR group at 6 months, and the ACL-RSI was higher at 6 (p < 0.001) and 12 (p = 0.007) months, there were no further differences. Hop and knee extensor strength LSIs were lower (p < 0.05) in the full MLKR (versus ACLR) cohort at all timepoints (apart from the 24-month SHD LSI). However, the ACLR group only demonstrated greater LSIs than the pivoting sport MLKR for the SHD at 6 months (p < 0.001), and knee extensor strength at 6 (p < 0.001) and 12 (p < 0.001) months.
CONCLUSIONS
While the recovery of patients undergoing MLKR due to a pivoting sports injury is delayed compared with their ACLR counterparts, the clinical outcome and activity profile are similar by 24 months.
LEVEL OF EVIDENCE
Level IV.
目的
本研究调查了在旋转运动损伤后，前交叉韧带重建（ACLR）与多韧带膝关节重建（MLKR）后的临床及基于活动的结局。
方法
纳入50例MLKR患者，其中20例（40%）在旋转运动中受伤。另外连续招募50例在旋转运动损伤后接受ACLR的患者进行比较。在手术前以及术后6个月、12个月和24个月，使用患者报告结局指标（PROMs）对患者进行评估，包括国际膝关节文献委员会（IKDC）表格、 Tegner活动量表（TAS）以及前交叉韧带损伤后恢复运动（ACL-RSI）评分。评估膝关节活动度、单腿（SHD）和双腿（THD）跳远距离测试以及等速膝关节伸肌和屈肌峰值力量，并计算肢体对称指数（LSIs）。对以下三组进行组间结果比较：（1）ACLR组（n = 50），（2）MLKR组（n = 50），（3）因旋转运动损伤导致的MLKR组（n = 20）。
结果
在所有时间点，整个MLKR组与ACLR组相比，IKDC、TAS和ACL-RSI评分均较低（p < 0.05）。比较ACLR组和尤其在旋转运动中受伤的MLKR组，ACLR组在6个月时IKDC评分（p < 0.001）和TAS评分（p = 0.009）较高，在6个月（p < 0.001）和12个月（p = 0.007）时ACL-RSI评分较高，之后无进一步差异。在所有时间点（24个月时的SHD LSI除外），整个MLKR组（与ACLR组相比）的跳远距离和膝关节伸肌力量LSIs较低（p < 0.05）。然而，ACLR组仅在6个月时SHD的LSI大于因旋转运动导致的MLKR组（p < 0.001），在6个月（p < 0.001）和12个月（p < 0.001）时膝关节伸肌力量大于该组。
结论
尽管因旋转运动损伤接受MLKR的患者恢复较ACLR患者延迟，但到24个月时临床结局和活动情况相似。
证据级别
四级
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