Saggar Rachit, Mhaskar Vikram Arun, Bansal Rohit
Vardhaman Mohair Medical College and Safdarjung Hospital, New Delhi, India.
Sitaram Bhartia Institute of Science and Research, New Delhi, India.
Eur J Orthop Surg Traumatol. 2024 Dec 12;35(1):39. doi: 10.1007/s00590-024-04161-9.
Recent advancements in surgical techniques have led to renewed interest in ACL repair, particularly for acute, proximal tears. Suture tape augmentation (STA) has emerged as a promising technique to support ACL healing while preserving native tissue and potentially improving outcomes. This study aims to evaluate the outcomes of ACL repair with STA in patients with acute, proximal ACL tears.
We retrospectively reviewed patients who underwent ACL repair with STA between June 2018 and October 2020. Inclusion criteria were acute (< 6 weeks) ACL rupture, Sherman type I tears, and minimum follow-up of 3 years. Exclusion criteria included mid-substance or distal ACL tears and previous knee surgeries. Clinical evaluation involved stability tests, PROMs, and gait analysis using Prokin WalkerView. Second-look arthroscopy and histological analysis were conducted on a subset of patients.
Twelve consecutive patients (7 males and 5 females) with a mean age of 27.4 ± 7.9 years and mean BMI of 23.3 ± 1.6 kg/mwere included. Time to operation was 19.5 ± 8.7 days. Mean follow-up duration was 53.2 ± 9.4 months. One patient experienced a traumatic re-rupture. One had a contralateral ACL tear and one experienced hardware irritation. Clinical tests were negative for instability in all patients. Post-operative IKDC, Lysholm, and FJS-12 scores showed significant improvement (p < 0.001). All patients (100%) achieved minimal clinically important difference for all PROMs. Walking gait analysis revealed high symmetry indices for range of motion (93.50%) and step length (95.80%) with near symmetrical loading. Second-look arthroscopy showed intact repairs with healthy tissue morphology and integration. Histology revealed increased cellularity, high nuclear density, and preservation of vascular and neural components indicated by CD34 and S-100 markers.
Arthroscopic ACL repair with STA provides favourable clinical, functional, and histological outcomes with low re-rupture rates when performed on acute, proximal ACL tears. This technique demonstrates fair-to-good PROMs, functional stability, and near-normal gait parameters.
外科技术的最新进展引发了人们对前交叉韧带（ACL）修复的新兴趣，尤其是对于急性近端撕裂伤。缝线带增强术（STA）已成为一种有前景的技术，可在保留天然组织的同时支持ACL愈合，并有可能改善治疗效果。本研究旨在评估采用STA对急性近端ACL撕裂伤患者进行ACL修复的效果。
我们回顾性分析了2018年6月至2020年10月期间接受STA ACL修复的患者。纳入标准为急性（<6周）ACL断裂、Sherman I型撕裂伤，且最短随访时间为3年。排除标准包括ACL中部或远端撕裂伤以及既往膝关节手术史。临床评估包括稳定性测试、患者报告结局测量（PROMs）以及使用Prokin WalkerView进行步态分析。对部分患者进行了二次关节镜检查和组织学分析。
连续纳入12例患者（7例男性和5例女性），平均年龄27.4±7.9岁，平均体重指数23.3±1.6kg/m²。手术时间为19.5±8.7天。平均随访时间为53.2±9.4个月。1例患者发生创伤性再断裂。1例对侧ACL撕裂，1例出现内植物刺激。所有患者的临床测试均未发现不稳定。术后国际膝关节文献委员会（IKDC）、Lysholm和FJS-12评分均有显著改善（p<0.001）。所有患者（100%）在所有PROMs方面均达到了最小临床重要差异。步行步态分析显示，运动范围（93.50%）和步长（95.80%）的对称性指数较高，负重接近对称。二次关节镜检查显示修复完整，组织形态健康且融合良好。组织学检查显示细胞增多、核密度高，CD34和S-100标记物表明血管和神经成分得以保留。
对于急性近端ACL撕裂伤，采用STA进行关节镜下ACL修复可提供良好的临床、功能和组织学效果，再断裂率低。该技术显示出较好至良好的PROMs、功能稳定性和接近正常的步态参数。
