Shoemaker Evan P, Tollefson Luke V, Kennedy Nicholas I, McGaver Rebecca Stone, Homan Morgan, Sieffert Kayla J, Shah Ayush D, Wulf Corey A, Larson Christopher M, Bjerke Brian P, LaPrade Robert F
Twin Cities Orthopedics, Edina, Minnesota, USA.
University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Orthop J Sports Med. 2024 Dec 20;12(12):23259671241303178. doi: 10.1177/23259671241303178. eCollection 2024 Dec.
A new "terrible triad" has been reported to be an anterior cruciate ligament (ACL) tear with a concomitant medial meniscus ramp tear and lateral meniscus root tear. Patient-reported outcomes (PROs) for isolated ACL reconstruction (ACLR) versus an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs are not well known.
To compare postoperative outcomes between isolated ACLR and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs.
Cohort study; Level of evidence, 3.
An initial cohort of 1228 patients with ACLRs were retrospectively identified between April 2016 and November 2021. A total of 41 patients with isolated ACLR (isolated cohort) were age and sex matched to 41 patients who had an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Patients in the triad cohort were identified consecutively by date of surgery. Preoperative and ≥2-year postoperative PROs were evaluated to compare the isolated cohort with the triad cohort. Statistical analysis was performed with unpaired tests and chi-square tests.
Both the isolated cohort and triad cohort demonstrated significant differences between preoperative and postoperative PROs in all questionnaire categories assessed. Postoperative scores for the International Knee Documentation Committee (isolated, 88.8; triad, 86.2; = .392), Cincinnati (isolated, 91.1; triad, 88.1; = .295), and Lysholm (isolated, 92.1; triad, 90.1; = .472) PROs demonstrated no significant differences between the cohorts. No significant difference was found between the isolated and triad cohorts for all preoperative questionnaire categories. Additionally, no significant difference was found in revision or reoperation rates between isolated and triad patients ( = .733).
No significant differences in PROs were found at minimum follow-up of 2 years postoperatively between the patients who underwent isolated ACLR (isolated cohort) and those who underwent ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Inferior outcomes were not observed in the triad cohort when revision rates, reoperation rates, and postoperative PROs were compared. Given the optimistic short-term outcomes for isolated versus triad ACLR patients and the known biomechanical consequences of these untreated meniscal injuries, medial meniscus ramp and lateral meniscus root repairs should be performed when encountered concurrently with an ACL tear when possible.
据报道，一种新的“可怕三联征”是前交叉韧带（ACL）撕裂合并内侧半月板斜坡撕裂和外侧半月板根部撕裂。孤立性ACL重建（ACLR）与合并内侧半月板斜坡和外侧半月板根部修复的ACLR的患者报告结局（PROs）尚不清楚。
比较孤立性ACLR与合并内侧半月板斜坡和外侧半月板根部修复的ACLR的术后结局。
队列研究；证据等级，3级。
回顾性确定2016年4月至2021年11月期间最初的1228例接受ACLR的患者队列。41例孤立性ACLR患者（孤立队列）在年龄和性别上与41例接受ACLR并同时进行内侧半月板斜坡和外侧半月板根部修复的患者（三联征队列）相匹配。三联征队列中的患者按手术日期连续确定。评估术前和术后≥2年的PROs，以比较孤立队列和三联征队列。采用非配对t检验和卡方检验进行统计分析。
在所有评估的问卷类别中，孤立队列和三联征队列术前和术后的PROs均显示出显著差异。国际膝关节文献委员会的术后评分（孤立队列，88.8；三联征队列，86.2；P = 0.392）、辛辛那提评分（孤立队列，91.1；三联征队列，88.1；P = 0.295）和Lysholm评分（孤立队列，92.1；三联征队列，90.1；P = 0.472）在队列之间无显著差异。在所有术前问卷类别中，孤立队列和三联征队列之间未发现显著差异。此外，孤立患者和三联征患者在翻修或再次手术率方面也未发现显著差异（P = 0.733）。
在术后至少2年的随访中，接受孤立性ACLR的患者（孤立队列）与接受ACLR并同时进行内侧半月板斜坡和外侧半月板根部修复的患者（三联征队列）之间在PROs方面未发现显著差异。在比较翻修率、再次手术率和术后PROs时，三联征队列未观察到较差的结局。鉴于孤立性与三联征性ACLR患者的短期结局乐观，以及这些未治疗的半月板损伤已知的生物力学后果，在可能的情况下，当与ACL撕裂同时出现时，应进行内侧半月板斜坡和外侧半月板根部修复。
