前交叉韧带重建术在 Schenck III 型和 IV 型膝关节脱位患者中比前交叉韧带修复术具有更好的稳定性。
ACL reconstruction demonstrates better stability compared to ACL repair for patients with Schenck III and IV knee dislocations.
机构信息
Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Trauma Surgery, Orthopaedics and Sportsorthopaedics, Asklepios St. Georg, Hamburg, Germany.
出版信息
Arch Orthop Trauma Surg. 2024 Sep;144(9):4325-4331. doi: 10.1007/s00402-024-05532-x. Epub 2024 Sep 9.
PURPOSE
This study compared mid-term outcomes of two anterior cruciate ligament (ACL) restoration techniques within an early total surgical care of acute knee dislocation: repair with additional internal bracing (ACLIB) and reconstruction with autograft (ACLR). Initial results at 12 months demonstrated that ACLR offered superior stability compared to ACLIB.
METHODS
Retrospective clinical study of patients with acute type III or IV KD. ACLIB or ACLR procedures were performed accompanied by simultaneous suture and internal bracing of the posterior cruciate ligament (PCL) and repair with lateral augmentation of the medial and lateral complex injuries utilizing Arciero's reconstruction technique. Patient-reported outcome measurements (PROMs), instrumental stability assessment via the Rolimeter-Test, and stress radiographs were analyzed.
RESULTS
The study involved 20 patients (5 IIIM, 5 IIIL, and 10 IV injuries) with an average follow-up of 35.2 ± 7.4 months. Notable differences in anterior tibial translation on stress radiography favouring ACLR persisted at 24-month follow-up in side-to-side difference (SSD) (ACLIB 2.8 ± 2.5 mm vs. ACLR 0.3 ± 2.6 mm; p = 0.0487), but Rolimeter test variance diminished (SSD ACLIB 2.5 ± 0.9 mm vs. ACLR 1.8 ± 1.7 mm). Both groups showed excellent PROMs (Lysholm Score: ACLIB 84.4 ± 15.8 vs. ACLR 89.9 ± 9.0; IKDC Score: ACLIB 77.1 ± 16.2 vs. ACLR 77.7 ± 8.6).
CONCLUSION
Our results indicate improved anterior stability at 12 months, which persisted at 24 months after ACL reconstruction compared with ACL repair by stress radiography. Both groups showed favourable patient-reported outcomes throughout the follow-up period. Notable rates of postoperative knee stiffness were observed in both groups. These were successfully managed with early, one-time arthroscopic arthrolysis within the first seven months of treatment, resulting in no major range of motion limitations at the 24-month follow-up.
LEVEL OF EVIDENCE
Retrospective cohort study, III.
目的
本研究比较了两种前交叉韧带（ACL）修复技术在急性膝关节脱位的早期综合治疗中的中期结果：带附加内支撑的修复（ACLIB）和自体移植物重建（ACLR）。12 个月时的初步结果表明，与 ACLIB 相比，ACLR 提供了更好的稳定性。
方法
回顾性研究了急性 III 型或 IV 型 KD 患者。同时进行 ACLIB 或 ACLR 手术，并同时缝合和内支撑后交叉韧带（PCL），利用 Arciero 的重建技术修复内侧和外侧复合体的外侧附加损伤。分析患者报告的结果测量（PROM）、通过 Rolimeter-Test 进行的仪器稳定性评估和应力射线照相。
结果
该研究涉及 20 名患者（5 例 IIIM、5 例 IIIL 和 10 例 IV 损伤），平均随访 35.2±7.4 个月。在 24 个月的随访中，在侧间差异（SSD）方面，前胫骨平移的明显差异有利于 ACLR，在应力射线照相中仍然存在（ACLIB 2.8±2.5mm 与 ACLR 0.3±2.6mm；p=0.0487），但 Rolimeter 测试方差减小（SSD ACLIB 2.5±0.9mm 与 ACLR 1.8±1.7mm）。两组患者的 PROM 均表现出色（Lysholm 评分：ACLIB 84.4±15.8 与 ACLR 89.9±9.0；IKDC 评分：ACLIB 77.1±16.2 与 ACLR 77.7±8.6）。
结论
我们的结果表明，与 ACL 修复相比，在 ACL 重建后 12 个月时，在应力射线照相中观察到的前稳定性得到改善，这种稳定性在 24 个月时仍然存在。两组患者在整个随访期间均表现出良好的患者报告结果。在两组中均观察到术后膝关节僵硬的发生率较高。这些在治疗的头 7 个月内通过单次、早期关节镜松解术成功治疗，在 24 个月的随访时没有出现主要的活动范围限制。
证据水平
回顾性队列研究，III 级。
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