ACL重建术后翻修风险与患者报告结局：合并MCL损伤及移植物选择的影响——基于挪威膝关节韧带登记库35,139例重建数据的分析
简介
基于挪威韧带登记处35,139例ACL重建数据，合并MCL损伤（无论手术或保守治疗）并不增加ACL翻修风险，但患者术后2年KOOS运动/娱乐评分更低且达标率下降。在合并MCL损伤且保守治疗的患者中，骨-髌腱-骨自体移植物翻修风险显著低于腘绳肌腱和股四头肌腱自体移植物，提示此类患者应优先考虑BPTB。
英文摘要
BACKGROUND: Concomitant medial collateral ligament (MCL) injury is common in anterior cruciate ligament (ACL) tears, but optimal management of these injury components remains controversial. PURPOSE: To compare patient-reported outcome measures and the risk of ACL revision surgery in patients with concomitant MCL injuries (treated operatively and nonoperatively) versus isolated ACL injuries and to assess whether MCL treatment strategy or ACL graft choice influenced outcomes. STUDY DESIGN: Cohort study; Level of evidence 3. METHODS: Data were obtained from the Norwegian Knee Ligament Register. Patients undergoing primary ACL reconstruction (ACLR) between 2004 and 2024 were included for graft-survival analyses, and those operated by December 31, 2022, were eligible for 2-year Knee injury and Osteoarthritis Outcome Score (KOOS) outcomes. Patients with concomitant ligament injuries other than to the MCL, ACL repairs, or those with unknown ACL graft type were excluded. Patients were stratified into isolated ACL and ACL + MCL injury groups. Kaplan-Meier survival analyses (unadjusted), multivariable Cox regression, and linear/logistic regression models were used, adjusted for descriptive data, body mass index, meniscal/cartilage injury, time to surgery, smoking, pivoting sports, graft choice, and baseline KOOS. RESULTS: A total of 35,139 ACLRs were included (2410 ACL + MCL and 32,729 isolated ACL; mean age, 28.6 years). Concomitant MCL injury was not associated with an increased overall risk of ACL revision (P = .5). However, ACL + MCL patients had lower 2-year KOOS Sport/Recreation (Sport/Rec) scores (-2 points, P = .04) and lower odds of achieving patient acceptable symptom state (PASS) for Sport/Rec. Within the ACL + MCL subgroup, hamstring (Hazard ratio [HR], 2.3; P = .001) and quadriceps autografts (HR, 3; P = .009) were associated with a higher revision risk compared with bone-patellar tendon-bone (BPTB) autograft, particularly when hamstring grafts were combined with nonoperative MCL treatment (HR, 2.4; P = .001). Graft choice did not influence the likelihood of achieving a minimal clinically important difference in KOOS. CONCLUSION: Concomitant MCL injury did not increase the risk of ACL revision but was associated with inferior KOOS Sport/Rec outcomes and lower odds of achieving PASS at 2 years. In patients with concomitant nonoperatively treated MCL injuries, BPTB autograft was associated with a significantly lower revision risk compared with hamstring and quadriceps autografts.