Okimura Shinichiro, Suzuki Tomoyuki, Kuroda Miki, Ikeda Yasutoshi, Shiwaku Kousuke, Teramoto Atsushi
Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Orthopaedic Surgery, Sapporo Maruyama Orthopaedic Hospital, Sapporo, Japan.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 2. doi: 10.1002/ksa.12741.
This study aimed to investigate whether one-stage revision anterior cruciate ligament reconstruction (ACLR) using the rectangular tunnel (RT) technique with a bone-tendon-bone (BTB) graft can achieve outcomes comparable to primary ACLR. It was hypothesized that both one-stage revision and primary ACLR using the RT technique with a BTB graft would provide comparable clinical outcomes.
We enroled 935 patients who underwent primary or revision ACLR by a single surgeon between 2012 and 2022. A 1:1 matching analysis was performed to balance demographic and clinical factors between the primary and revision ACLR groups. Matching factors included age, sex, body mass index, follow-up period, pre-injury Tegner activity scale and the presence of meniscus injury. Clinical evaluations were performed both preoperatively and at the final follow-up, including physical examinations and clinical outcome scores (Knee injury and Osteoarthritis Outcome Score [KOOS] and International Knee Documentation Committee [IKDC] Knee Examination Form 2000). Knee joint laxity was assessed using the Lachman and pivot shift tests, along with the knee arthrometer. Continuous and categorical variables were analyzed using an independent t test and Fisher's exact probability test, respectively. Survivorship was assessed by plotting the Kaplan‒Meier survival curves.
After matching, 128 patients were assigned to each group, with mean follow-up periods of 41.7 and 44.5 months in the primary and revision groups, respectively. Post-operative assessments showed no significant between-group differences in knee joint laxity or KOOS subscale scores. Based on the IKDC grading, patients were classified as either normal or nearly normal. Kaplan‒Meier survival analysis showed no significant between-group differences in survival rates.
Comparable post-operative knee stability and clinical outcomes were observed in both the one-stage revision and primary ACLR groups, highlighting the importance of precise surgical techniques in achieving consistent revision ACLR outcomes and suggesting that the RT technique may contribute to more reliable results in this challenging setting.
Level III, retrospective cohort study.
本研究旨在探讨采用矩形隧道（RT）技术和骨-肌腱-骨（BTB）移植物进行一期翻修前交叉韧带重建（ACLR）是否能取得与初次ACLR相当的结果。研究假设采用RT技术和BTB移植物进行一期翻修和初次ACLR均能提供相当的临床结果。
我们纳入了935例在2012年至2022年间由同一位外科医生进行初次或翻修ACLR的患者。进行1:1匹配分析以平衡初次和翻修ACLR组之间的人口统计学和临床因素。匹配因素包括年龄、性别、体重指数、随访期、伤前Tegner活动量表以及半月板损伤情况。术前和末次随访时均进行临床评估，包括体格检查和临床结果评分（膝关节损伤和骨关节炎结果评分[KOOS]以及国际膝关节文献委员会[IKDC]2000版膝关节检查表）。使用Lachman试验、轴移试验以及膝关节测角仪评估膝关节松弛度。连续变量和分类变量分别采用独立t检验和Fisher精确概率检验进行分析。通过绘制Kaplan-Meier生存曲线评估生存率。
匹配后，每组各有128例患者，初次组和翻修组的平均随访期分别为41.7个月和44.5个月。术后评估显示，两组之间在膝关节松弛度或KOOS子量表评分方面无显著差异。根据IKDC分级，患者被分类为正常或接近正常。Kaplan-Meier生存分析显示，两组之间的生存率无显著差异。
一期翻修组和初次ACLR组术后膝关节稳定性和临床结果相当，突出了精确手术技术在实现一致的翻修ACLR结果中的重要性，并表明RT技术可能有助于在这一具有挑战性的情况下获得更可靠的结果。
III级，回顾性队列研究。
