特定患者队列中的前交叉韧带初次修复：一项前瞻性单队列研究。
Primary ACL repair in a selected patient cohort: A prospective single cohort study.
作者信息
Al Kindi Ibtihal, Al Rawahi Salim, Al Ghaithi Ahmed, Al Yarubi Said, Al Masakri Sultan, Al Mutaini Mohammed
机构信息
Orthopedic Surgery Department, Sultan Qaboos University Hospital, Muscat, Oman.
Division of Orthopedic Surgery, Department of Surgery, McGill University, Montreal, Quebec, Canada.
出版信息
J Orthop. 2024 Oct 2;61:127-132. doi: 10.1016/j.jor.2024.09.020. eCollection 2025 Mar.
BACKGROUND
Anterior cruciate ligament (ACL) tears are common knee injuries, particularly in physically active individuals. While ACL reconstruction (ACL-R) is the standard treatment, it has notable limitations. Recent interest in primary ACL repair offers a potential alternative, especially for specific tear types and patient demographics.
PURPOSE
To evaluate the outcomes of primary ACL repair in a selected patient cohort with strict inclusion and exclusion criteria, focusing on the survival of the procedure, functional outcomes, and factors influencing success rates.
METHODS
This prospective single cohort study included 61 patients who underwent primary ACL repair between June 2016 and June 2022. Patients were 50 years or younger, with recent ACL injuries and no previous knee surgeries or multiligament injuries. The primary outcomes were the survival of the repair beyond two years, measured by revision rates, and functional outcomes assessed using the Lysholm knee score, Tegner activity scale, and Lachmeter stability measurements.
RESULTS
Fifty-four patients completed a minimum follow-up of three years (average 49.6 months). The overall success rate was 82.2 %, with Sherman type 1 tears showing significantly fewer failures compared to type 2 (4.3 % vs. 31.8 %). The mean Lysholm score for successful repairs was 96, and the Tegner score dropped from a pre-injury average of 6 to 5. Adolescents had the highest failure rate (50 %), while other age groups showed better outcomes. The mean side-to-side difference in stability was 1.4 mm, favoring the control side.
CONCLUSION
Primary ACL repair is a viable option for selected patients, particularly those with Sherman type 1 tears. While age and tear type significantly affect outcomes, the procedure shows promising results with high functional scores in successful repairs. Further research with larger cohorts and extended follow-ups is necessary to validate these findings and refine patient selection criteria. Primary ACL repair offers a less invasive alternative to ACL reconstruction, with potential for comparable outcome.
背景
前交叉韧带（ACL）撕裂是常见的膝关节损伤，在体力活动频繁的人群中尤为常见。虽然ACL重建术（ACL-R）是标准治疗方法，但它有显著局限性。近期对初次ACL修复的关注提供了一种潜在的替代方案，特别是针对特定的撕裂类型和患者群体。
目的
在具有严格纳入和排除标准的特定患者队列中评估初次ACL修复的结果，重点关注手术的成功率、功能结果以及影响成功率的因素。
方法
这项前瞻性单队列研究纳入了2016年6月至2022年6月期间接受初次ACL修复的61例患者。患者年龄在50岁及以下，近期发生ACL损伤，且既往无膝关节手术史或多韧带损伤。主要结局指标为两年以上修复的成功率，通过翻修率衡量，以及使用Lysholm膝关节评分、Tegner活动量表和Lachmeter稳定性测量评估的功能结果。
结果
54例患者完成了至少三年的随访（平均49.6个月）。总体成功率为82.2%，与2型相比，Sherman 1型撕裂的失败率显著更低（4.3%对31.8%）。成功修复的平均Lysholm评分为96分，Tegner评分从损伤前的平均6分降至5分。青少年的失败率最高（50%），而其他年龄组的结果更好。稳定性的平均左右差异为1.4毫米，优势在对照侧。
结论
初次ACL修复对于特定患者是一种可行的选择，特别是那些患有Sherman 1型撕裂的患者。虽然年龄和撕裂类型显著影响结果，但该手术在成功修复中显示出有希望的结果，功能评分较高。需要进行更大队列和更长随访时间的进一步研究来验证这些发现并完善患者选择标准。初次ACL修复为ACL重建提供了一种侵入性较小的替代方案，有可能获得相当的结果。
Zotero 插件