平均年龄60岁患者队列中过顶技术前交叉韧带重建联合外侧关节外腱固定术的临床结局与失败率
简介
本研究纳入28例平均年龄60岁、随访6.5年的ACL损伤患者，采用Over-the-top（OTT）技术联合外侧关节外肌腱固定术（LET）重建ACL。术后仅1例移植物失败（3.6%），Lysholm评分由术前55.4升至96.6，KOOS各亚项均显著改善。提示该联合术式在老年患者中失败率低、临床效果良好，但属IV级证据，需更大样本验证。
英文摘要
PURPOSE: The management of anterior cruciate ligament (ACL) tears in older adults remains controversial, although recent evidence suggests an increasing trend toward surgical treatment. To date, no studies have specifically investigated the outcomes of combined ACL reconstruction (ACLR) with over-the-top (OTT) technique and lateral extra-articular tenodesis (LET) in this population. The aim of this study was to evaluate clinical outcomes and failure rates of ACLR using OTT plus LET in patients aged 55 years or older. METHODS: Patients aged ≥55 years who underwent primary ACLR with OTT and LET techniques and had a minimum follow-up of 2 years were included. Clinical outcomes were assessed using clinical scores, such as VAS, Lysholm, KOOS, comparing preoperative and post-operative values. Patient Acceptable Symptom State (PASS) thresholds were applied to KOOS subscales. Reoperations and graft failures were also recorded. RESULTS: Twenty-eight patients met the inclusion criteria, with a mean age of 60.1 ± 3.2 years and a mean follow-up of 6.5 ± 3.8 years. One graft failure (3.6%) and one reoperation (3.6%) were observed. Significant improvements were noted in all clinical scores. The mean Lysholm score increased from 55.4 ± 15.9 preoperatively to 96.6 ± 6.6 postoperatively. KOOS subscales showed marked improvement, particularly in Quality of Life (41.6 ± 20.2 to 90.3 ± 12.9) and Pain (68.7 ± 12.1 to 94.2 ± 5.7). CONCLUSION: ACLR with OTT and LET techniques in older patients demonstrated low failure rates and favourable clinical outcomes. Larger studies are needed to confirm these findings and to establish the role of this combined technique in this population. LEVEL OF EVIDENCE: Level IV.