Investigation performed at Vanderbilt University, Nashville, Tennessee, USA.
Vanderbilt University, Nashville, TN, USA.
Am J Sports Med. 2024 Nov;52(13):3286-3294. doi: 10.1177/03635465241288227.
Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown.
To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up.
Cohort study; Level of evidence, 2.
Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery.
A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; = .008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; < .01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; = .001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; < .05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; < .05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; ≤ .04).
There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients' odds of having a significantly better 6-year clinical outcome in this cohort.
与初次前交叉韧带（ACL）重建相比，翻修 ACL 重建的结果较差。其原因尚不清楚。
确定在翻修 ACL 重建时实施的手术因素是否会影响患者在 6 年随访时的结果。
队列研究；证据水平，2 级。
在 2006 年至 2011 年间确定并前瞻性招募接受翻修 ACL 重建的患者。收集的数据包括基线患者特征、手术技术和病理以及一系列经过验证的患者报告的结局评估工具：膝关节损伤和骨关节炎结局评分（KOOS）、国际膝关节文献委员会（IKDC）主观评分、西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）和 Marx 活动评分。患者随访 6 年，并要求完成相同的一系列结局评估工具。回归分析用于控制基线患者特征和手术变量，以评估手术后 6 年临床结局的手术危险因素。
共纳入 1234 例患者（716 例男性，58%；中位年龄 26 岁），980/1234 例（79%）获得了 6 年的随访。与使用交叉钉相比，使用股骨固定的干扰螺钉可显著改善 6 年 IKDC 评分（比值比[OR]，2.2；95%置信区间，1.2-3.9； =.008）和 KOOS 运动/娱乐和生活质量亚量表评分（OR 范围，2.2-2.7；95%置信区间，1.2-4.8； <.01）。与使用交叉钉相比，使用干扰螺钉的患者在 6 年内再次手术的可能性降低了 2.6 倍。与任何胫骨固定技术组合相比，使用胫骨固定的干扰螺钉可显著改善 IKDC（OR，1.96；95%置信区间，1.3-2.9； =.001）评分；KOOS 疼痛、日常生活活动和运动/娱乐亚量表（OR 范围，1.5-1.6；95%置信区间，1.0-2.4； <.05）；以及 WOMAC 疼痛和日常生活活动亚量表（OR 范围，1.5-1.8；95%置信区间，1.0-2.7； <.05）。与前内侧入路相比，使用经胫骨手术入路可显著改善 6 年时 KOOS 疼痛和生活质量亚量表评分（OR，1.5；95%置信区间，1.02-2.2；≤.04）。
在 ACL 翻修时存在手术变量，可以在 6 年内改变临床结局。在本队列中，选择经胫骨手术入路并选择股骨和胫骨固定的干扰螺钉可提高患者在 6 年内获得明显更好临床结局的几率。
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