在解剖学双束前交叉韧带重建术后一年，大多数患者实现了患者可接受的症状状态以及国际膝关节文献委员会主观膝关节评分的最小临床重要差异。
A majority of the patient achieved both patient-acceptable symptom state and minimal clinically important difference of International Knee Documentation Committee Subjective Knee Form score at one year after anatomical double-bundle anterior cruciate ligament reconstruction.
作者信息
Tokura Takeo, Hoshino Yuichi, Nagai Kanto, Nishida Kyohei, Kanzaki Noriyuki, Matsushita Takehiko, Kuroda Ryosuke
机构信息
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
出版信息
J ISAKOS. 2024 Dec;9(6):100344. doi: 10.1016/j.jisako.2024.100344. Epub 2024 Oct 11.
OBJECTIVES
There is a paucity of data about clinical outcomes after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the concepts of patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID). The aim of the present study was to evaluate the one-year clinical outcomes of patients who underwent DB-ACLR using PASS and MCID.
METHODS
Achievement of PASS and MCID were retrospectively evaluated for 298 (mean age 26.9 years; 145 men/153 women) and 214 patients (mean age 23.9 years; 114 males/100 females), respectively, who underwent primary DB-ACLR using a hamstring autograft. For patients who achieved PASS or MCID, demographics, preoperative and postoperative data were statistically analyzed.
RESULTS
Of 298 patients, 254 (85.2%) achieved International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) PASS and 191 out of 214 patients (88.8%) achieved MCID. The dichotomous logistic regression analyses to assess the achievement of PASS showed that younger age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93-0.99; P = 0.013), male sex (OR, 2.2; 95% CI, 1.08-4.83; P = 0.030) and better one-year quadriceps strength symmetry (OR, 1.05; 95% CI, 1.03-1.07; P < 0.001) were independent predictors of PASS achievement. For MCID, preoperative IKDC-SKF score below the 50th percentile (OR, 14.39; 95% CI, 2.90-71.25; P = 0.001) and better one-year quadriceps strength symmetry (OR, 1.035; 95% CI, 1.007-1.064; P = 0.014) were independent predictors for MCID achievement.
CONCLUSIONS
More than 85% of the patients achieved PASS and MCID for the IKDC-SKF score one year after undergoing DB-ACLR with hamstring tendon autograft. Better quadriceps strength symmetry at one year contributed to the achievement of both PASS and MCID. Rehabilitation dedicated to quadriceps strength recovery may be important for achieving good clinical outcomes after DB-ACLR.
LEVEL OF EVIDENCE
IV, retrospective cohort.
目的
关于采用患者可接受症状状态（PASS）和最小临床重要差异（MCID）概念进行双束前交叉韧带重建（DB-ACLR）后的临床结果，相关数据较少。本研究的目的是评估采用PASS和MCID进行DB-ACLR的患者的一年临床结果。
方法
分别对298例（平均年龄26.9岁；145例男性/153例女性）和214例患者（平均年龄23.9岁；114例男性/100例女性）进行回顾性评估，这些患者均采用自体腘绳肌腱进行初次DB-ACLR。对于达到PASS或MCID的患者，对其人口统计学特征、术前和术后数据进行统计分析。
结果
在298例患者中，254例（85.2%）达到国际膝关节文献委员会主观膝关节评分表（IKDC-SKF）的PASS，214例患者中有191例（88.8%）达到MCID。评估PASS达成情况的二分类逻辑回归分析显示，年龄较小（优势比[OR]，0.96；95%置信区间[CI]，0.93-0.99；P = 0.013）、男性（OR，2.2；95%CI，1.08-4.83；P = 0.030）和一年期股四头肌力量对称性更好（OR，1.05；95%CI，1.03-1.07；P < 0.001）是PASS达成的独立预测因素。对于MCID，术前IKDC-SKF评分低于第50百分位数（OR，14.39；95%CI，2.90-71.25；P = 0.001）和一年期股四头肌力量对称性更好（OR，1.035；95%CI，1.007-1.064；P = 0.014）是MCID达成的独立预测因素。
结论
超过85%的患者在采用自体腘绳肌腱进行DB-ACLR后一年，IKDC-SKF评分达到PASS和MCID。一年期更好的股四头肌力量对称性有助于PASS和MCID的达成。致力于股四头肌力量恢复的康复训练对于DB-ACLR后获得良好的临床结果可能很重要。
证据水平
IV，回顾性队列研究。
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