Inclan Paul M, Rai Muhammad Farooq, Chen Ling, Brophy Robert H
From the Sports Medicine Institute, Hospital for Special Surgery-New York, NY (Inclan), the Department of Biological Sciences, College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates (Rai), the Center for Biotechnology, Khalifa University, Abu Dhabi, United Arab Emirates (Rai), the Division of Rheumatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO (Rai), the Department of Biomedical Engineering, Saint Louis University School of Science and Engineering, St. Louis, MO (Rai), and the Department of Orthopaedic Surgery, Washington University School of Medicine-Saint Louis, MO (Chen and Brophy).
J Am Acad Orthop Surg. 2025 Apr 17;33(13):e758-e764. doi: 10.5435/JAAOS-D-24-00468.
Aspiration of a posttraumatic hemarthrosis has been postulated to improve pain and reduce the burden of proinflammatory cytokines and chemokines that accumulate in the aftermath of an acute anterior cruciate ligament injury. However, the clinical implications of routine aspiration have not been fully investigated. The purpose of this study was to determine the effect of routine preoperative aspiration on (1) the development of arthrofibrosis and (2) overall revision surgery rate following ACL reconstruction (ACLr).
The population of interest for this study was individuals with an isolated (ie, without notable concurrent ligamentous or chondral injury) ACL rupture indicated for ACLr, with or without concurrent meniscal pathology. Patients were randomized to either routine preoperative care or in-office aspiration of their traumatic effusion upon initial presentation. Patients underwent routine diagnostic arthroscopy at the time of ACLr to evaluate for concurrent chondral or meniscal pathology. Patients underwent standard postoperative rehabilitation and follow-up care.
Eighty-seven patients were enrolled in this study, with 46 patients (53%) undergoing preoperative aspiration. At a mean follow-up of 2.54 ± 1.34 years, 14 of 87 patients (16%) underwent revision surgery for any reason and 10 patients (11.5%) underwent débridement of arthrofibrosis. Preoperative aspiration was not markedly associated with a decreased rate of revision surgery or arthrofibrosis. However, aspiration was markedly associated with a longer time to débridement for arthrofibrosis (125 vs. 457 days; P = 0.0029).
Preoperative aspiration does not modify rates of subsequent surgery following ACLr. Arthrofibrosis developed markedly later in patients who were aspirated preoperatively, possibly as a result of decreased intra-articular inflammation.
创伤后关节积血的抽吸被认为可改善疼痛，并减轻急性前交叉韧带损伤后积聚的促炎细胞因子和趋化因子的负担。然而，常规抽吸的临床意义尚未得到充分研究。本研究的目的是确定常规术前抽吸对（1）关节纤维化的发展以及（2）前交叉韧带重建（ACLr）术后总体翻修手术率的影响。
本研究的目标人群是因ACLr而有孤立性（即无明显并发韧带或软骨损伤）ACL断裂的个体，无论是否并发半月板病变。患者在初次就诊时被随机分为接受常规术前护理或在门诊抽吸创伤性积液。患者在ACLr时接受常规诊断性关节镜检查，以评估是否并发软骨或半月板病变。患者接受标准的术后康复和随访护理。
本研究共纳入87例患者，其中46例（53%）接受了术前抽吸。平均随访2.54±1.34年时，87例患者中有14例（16%）因任何原因接受了翻修手术，10例患者（11.5%）接受了关节纤维化清创术。术前抽吸与翻修手术率或关节纤维化的降低无明显关联。然而，抽吸与关节纤维化清创术的时间明显延长相关（125天对457天；P=0.0029）。
术前抽吸不会改变ACLr术后的后续手术率。术前抽吸的患者关节纤维化明显延迟出现，可能是由于关节内炎症减轻所致。
