初次前交叉韧带重建联合与不联合前外侧肌腱固定术的短期患者报告结局：来自瑞典膝关节韧带注册库的匹配队列分析
简介
基于瑞典膝关节韧带登记处的大样本匹配队列研究（174例ACL-R+LET vs 696例单纯ACL-R），比较术后1年和2年的患者报告结局（KOOS4）。结果显示，两组在KOOS4评分、ACL翻修率（2.3% vs 2.4%）及临床失败率（约25.5%）方面均无显著差异。提示在初次ACL重建中加行LET并未带来短期PROs获益。
英文摘要
BACKGROUND: Despite reduced graft failure rates reported in randomized controlled trials comparing anterior cruciate ligament reconstruction (ACL-R) with and without lateral extra-articular tenodesis (LET), the impact of LET on postoperative patient-reported outcomes (PROs) remains poorly defined. PURPOSE: To compare short-term PROs, as well as anterior cruciate ligament (ACL) revision rates and clinical failure rates (defined as Knee injury and Osteoarthritis Outcome Score [KOOS] Quality of Life [QoL] value <44) between patients undergoing primary ACL-R with and without concomitant LET. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Data were extracted from the Swedish Knee Ligament Registry for all patients undergoing primary ACL-R between January 1, 2005, and June 25, 2025. Patients who underwent ACL-R + LET were matched to patients who underwent ACL-R without LET using 1:4 matching based on age, sex, body mass index, graft type, time from injury to reconstruction, and concomitant meniscal and cartilage injury status. The primary outcomes were KOOS values at the 1- and 2-year follow-ups.Secondary outcomes included revision ACL-R and clinical failure within 1 and 2 years. Categorical variables were compared using Fisher exact or chi-square tests, continuous variables were compared using Fisher nonparametric permutation tests, and within-group KOOS changes were compared using Wilcoxon signed-rank tests. Adjusted 1- and 2-year KOOS Symptoms comparisons for baseline differences and outcomes were interpreted relative to published minimal clinically important difference thresholds. RESULTS: After matching, the final cohort consisted of 870 patients: 174 in the ACL-R + LET group and 696 in the ACL-R group. There were no significant between-group differences in KOOS4 (mean of the Symptoms, Pain, Sports and Recreation, and QoL subscales) scores at the 1-year (77.7 ± 15.2 for ACL-R + LET vs 78.8 ± 14.9 for ACL-R) or 2-year (79.9 ± 16.7 for ACL-R + LET vs 80.7 ± 13.4 for ACL-) follow-up (P > .5). Both groups demonstrated significant within-group improvements in KOOS4 scores from baseline through the 2-year follow-up (all P≤ .002). ACL revision rates at 2 years were 2.3% and 2.4% in the ACL-R + LET and ACL-R groups, respectively. Rates of clinical failure at 2 years were similar between groups (25.5% for ACL-R + LET vs 25.6% for ACL-R; P > .99). CONCLUSION: In this matched-cohort registry study, the addition of LET to primary ACL-R did not demonstrate superior short-term PROs at 1 or 2 years postsurgery.