中老年患者前交叉韧带近端修复联合缝线增强的中期耐久生存率：一项危险因素分析
简介
该研究评估了中年前交叉韧带（ACL）近端撕裂采用缝线增强修复术的中期存活率及翻修风险因素。共纳入80例患者（平均年龄42岁），中位随访79个月。结果显示，13例（16%）需翻修手术（6例再撕裂、7例慢性不稳），1年、5年及7年无翻修存活率分别为94%、88%和83%。年龄、BMI、性别、手术时机、半月板或韧带损伤及康复时长均与翻修无显著相关。临床意义：缝线增…
英文摘要
PURPOSE: Arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears with suture augmentation (SA) provides a ligament-preserving alternative to reconstruction. Evidence on mid-term durability and associated risk factors for revision remains limited. This study evaluated revision-free survival at a minimum follow-up of 72 months and identified risk factors for revision. METHODS: A consecutive cohort undergoing arthroscopic proximal ACL repair with SA, performed by a single surgeon between 2017 and 2019, was analysed. Revision-free survival was determined using Kaplan-Meier analysis with 95% confidence interval (CI). Risk factors were evaluated using parametric or non-parametric tests; significance was set at p < 0.05. RESULTS: A minimum follow-up of 72 months (median 79, interquartile range [IQR] 75-97) was completed by 80 patients (23 males; mean age 42 ± 13 years). Revision surgery was required in 13 patients (16%) after a median of 38 months, including six re-ruptures and seven chronic instabilities. Revision-free survival was 94% at 1 year, 88% at 5 years and 83% at 7 years. Age, body mass index (BMI), sex, surgical timing, meniscal or ligamentous injury and physiotherapy duration showed no significant associations. CONCLUSION: Arthroscopic proximal ACL repair with SA demonstrated durable survivorship exceeding 80% at 7 years. While preoperative Tegner score showed an exploratory association with revision risk, no independent predictor of failure was confirmed. These findings support proximal ACL repair with SA as a ligament-preserving option for carefully selected patients, particularly in middle-aged individuals with moderate mechanical demand. Generalizability to younger, high-demand athletes requires further prospective evidence. LEVEL OF EVIDENCE: Level III, retrospective cohort study.