Bacevich Blake M, Hazzard Sean, Lustig Mia, Connelly Saoirse, Nukala Varun, Asnis Peter
Harvard Medical School, Boston, Massachusetts, U.S.A.
Department of Orthopaedics/Sports Medicine Service, Massachusetts General Hospital, Waltham, Massachusetts, U.S.A.
Arthrosc Sports Med Rehabil. 2024 Nov 9;7(2):101038. doi: 10.1016/j.asmr.2024.101038. eCollection 2025 Apr.
To investigate the influence of the timing of anterior cruciate ligament (ACL) reconstruction (ACLR) on patient-reported outcomes, comparing patients with and without concomitant medial collateral ligament (MCL) injury.
This study included patients who underwent ACLR between September 2015 and October 2020. The inclusion criteria included patients for whom preoperative and postoperative patient-reported outcome measures were available and a follow-up period of at least 2 years. Patients who sustained grade 2 or 3 MCL injuries with ACL tears were compared with patients with no MCL injuries as a control. All patients underwent ACLR with either bone-tendon-bone autograft or bone-tendon-bone allograft. Patient-reported outcomes (International Knee Documentation Committee [IKDC] score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score [KOOS]) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted.
A total of 253 eligible patients with 2-year outcomes were enrolled. Patients with combined ACL-MCL injuries had lower IKDC scores (β = -6.1 vs β = -8.3, = .003), KOOS Quality of Life values (β = -9.3 vs β = -11, = .004), and KOOS Sport values (β = -12 vs β = -13, = .08) if surgery was performed more than 6 weeks after the index injury. Patients with isolated ACL injuries showed lower KOOS Activities of Daily Living values (β = -2.4, = .045) if surgery was performed at between 3 and 6 months. Among patients with combined ACL-MCL injuries, autograft was found to have worse IKDC scores (β = -11 [95% confidence interval (CI), -18 to -4.2]; = .002), Lysholm scores (β = -9.2 [95% CI, -15 to -3.1]; = .004), KOOS Quality of Life values (β = -11 [95% CI, -20 to -1.6]; = .023), KOOS Pain values (β = -5.1 [95% CI, -10 to -0.03]; = .049), KOOS Symptoms values (β = -7.6 [95% CI, -10 to -0.03]; = .02), and KOOS Sport values (β = -21 [95% CI, -32 to -10]; < .001) than allograft.
Patients undergoing ACLR with grade 2 or 3 MCL injuries have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts.
Level III, retrospective cohort study.
探讨前交叉韧带（ACL）重建（ACLR）时机对患者报告结局的影响，并比较合并和未合并内侧副韧带（MCL）损伤的患者。
本研究纳入了2015年9月至2020年10月期间接受ACLR的患者。纳入标准包括术前和术后有患者报告结局测量数据且随访期至少2年的患者。将发生2级或3级MCL损伤伴ACL撕裂的患者与无MCL损伤的患者作为对照进行比较。所有患者均采用骨-腱-骨自体移植物或骨-腱-骨同种异体移植物进行ACLR。记录患者报告结局（国际膝关节文献委员会[IKDC]评分、Lysholm评分和膝关节损伤与骨关节炎结局评分[KOOS]），并按性别和距初次损伤的时间分析结局。进行分层线性混合效应回归分析。
共纳入253例有2年结局的合格患者。如果在初次损伤后6周以上进行手术，合并ACL-MCL损伤的患者的IKDC评分（β=-6.1对β=-8.3，P=.003）、KOOS生活质量值（β=-9.3对β=-11，P=.004）和KOOS运动值（β=-12对β=-13，P=.08）较低。如果在3至6个月之间进行手术，单纯ACL损伤的患者的KOOS日常生活活动值较低（β=-2.4，P=.045）。在合并ACL-MCL损伤的患者中，发现自体移植物的IKDC评分（β=-11[95%置信区间（CI），-18至-4.2]；P=.002）、Lysholm评分（β=-9.2[95%CI，-15至-3.1]；P=.004）、KOOS生活质量值（β=-11[95%CI，-20至-1.6]；P=.023）、KOOS疼痛值（β=-5.1[95%CI，-10至-0.03]；P=.049）、KOOS症状值（β=-7.6[95%CI，-10至-0.03]；P=.02）和KOOS运动值（β=-21[95%CI，-32至-10]；P<.001）均比同种异体移植物差。
对于2级或3级MCL损伤的患者，如果在受伤后6周内进行ACLR手术，患者报告结局会有所改善。在本队列中，与自体移植物相比，同种异体移植物的结局评分更好。
III级，回顾性队列研究。
