Conner-Rilk Sebastian, Goodhart Gabriel C, von Rehlingen-Prinz Fidelius, van der List Jelle P, Kunze Kyle N, Tomanek Fabian, O'Brien Robert J, DiFelice Gregory S
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Medical University of Vienna, Vienna, Austria.
Am J Sports Med. 2025 Jul;53(8):1901-1911. doi: 10.1177/03635465251340087. Epub 2025 May 23.
Primary anterior cruciate ligament (ACL) repair (ACLPR) demonstrates promising short-term clinical outcomes in select patients; however, it remains poorly understood as to whether previously reported short-term outcomes are maintained at midterm follow-up.
To determine whether short-term (2-year) outcomes are maintained at 5 years after ACLPR, evaluate age-stratified failure and reoperation rates, and identify preoperative risk factors for failure.
Case series; Level of evidence, 4.
This prospective study included the first 113 consecutive patients with proximal (type I/II) ACL tears who underwent ACLPR between 2008 and 2017 with a minimum 5-year follow-up. Failure rates were recorded based on instrumented laxity (>3-mm anterior tibial translation side-to-side difference), pivot-shift grade (grade ≥2), and subjective instability. Patient Acceptable Symptom State thresholds were established based on collected patient-reported outcome measure scores. Logistic regression models were constructed to determine associations with independent risk factors for failure.
A total of 107 patients (median age, 35.5 years [interquartile range, 22.4-43.1 years]) were available at final follow-up (median, 6.0 years [interquartile range, 5.3-7.0 years]). No significant differences were reported in failure rates between 2- and 5-year follow-up: overall non-age-differentiated: 11.5% versus 15.9%, respectively ( = .34); ≤21 years: 37.0% versus 38.5%, respectively ( = .92); and >21 years: 3.5% versus 8.6%, respectively ( = .16). No failures occurred in patients aged ≤21 years, while 4 failures occurred in patients aged >21 years. Additionally, no significant differences were observed in overall non-age-differentiated reoperation rates (6.2% vs 7.5%, respectively; = .71) and contralateral ACL injury rates (3.5% vs 4.7%, respectively; = .67). Clinical outcomes and patient-reported outcome measure scores did not significantly differ between time points, and most patients met Patient Acceptable Symptom State thresholds (88% for International Knee Documentation Committee form, 91% for Lysholm scale, 93% for Forgotten Joint Score-12, and 84% for ACL-Return to Sport after Injury scale; all < .001). Preoperative risk factor analysis only revealed younger age as negatively impacting ipsilateral ACL failure, as the odds decreased by 12.5% for each year of increasing age ( = .002).
Sustained clinical and functional outcomes for ACLPR were observed between short-term and midterm follow-up, with failure rates of 11.5% and 15.9%, respectively. Although younger age was an important risk factor for ipsilateral ACL failure, with a high failure rate of 37.0% in patients aged ≤21 years at short-term follow-up, no additional failures were observed at midterm follow-up. In contrast, patients aged >21 years experienced modest failure rates, increasing from 3.5% at short-term follow-up to 8.6% at midterm follow-up, with no significant change.
在特定患者中，原发性前交叉韧带（ACL）修复术（ACLPR）显示出良好的短期临床效果；然而，此前报道的短期效果在中期随访时是否仍能维持，目前仍知之甚少。
确定ACLPR术后2年的短期效果在5年时是否仍能维持，评估按年龄分层的失败率和再次手术率，并确定术前失败的危险因素。
病例系列；证据等级，4级。
这项前瞻性研究纳入了2008年至2017年间连续接受ACLPR的前113例近端（I/II型）ACL撕裂患者，随访时间至少5年。根据仪器测量的松弛度（胫骨前移侧方差异>3mm）、轴移分级（≥2级）和主观不稳定情况记录失败率。根据收集的患者报告结局测量分数确定患者可接受症状状态阈值。构建逻辑回归模型以确定与失败的独立危险因素的关联。
最终随访时共有107例患者（中位年龄35.5岁[四分位间距，22.4 - 43.1岁]）（中位随访时间6.0年[四分位间距，5.3 - 7.0年]）。2年和5年随访的失败率无显著差异：总体不分年龄：分别为11.5%和15.9%（P = 0.34）；≤21岁：分别为37.0%和38.5%（P = 0.92）；>21岁：分别为3.5%和8.6%（P = 0.16）。≤21岁的患者未发生失败，而>21岁的患者发生了4例失败。此外，总体不分年龄的再次手术率（分别为6.2%和7.5%；P = 0.71）和对侧ACL损伤率（分别为3.5%和4.7%；P = 0.67）无显著差异。不同时间点的临床效果和患者报告结局测量分数无显著差异，大多数患者达到了患者可接受症状状态阈值（国际膝关节文献委员会表格为88%，Lysholm量表为91%，遗忘关节评分-12为93%，ACL损伤后恢复运动量表为84%；均P < 0.001）。术前危险因素分析仅显示年龄较小对同侧ACL失败有负面影响，年龄每增加一岁，几率降低12.5%（P = 0.002）。
在短期和中期随访中均观察到ACLPR具有持续的临床和功能效果，失败率分别为11.5%和15.9%。虽然年龄较小是同侧ACL失败的重要危险因素，≤21岁的患者在短期随访时失败率高达37.0%，但在中期随访时未观察到额外的失败病例。相比之下，>21岁的患者失败率适中，从短期随访时的3.5%增加到中期随访时的8.6%，无显著变化。
