前交叉韧带损伤的慢性期不会对经恰当选择患者行一期修复的临床结局产生不利影响
简介
该研究纳入276例接受关节镜下ACL初次修复术（ACLPR）的完全性近端（I/II型）撕裂患者，按手术延迟时间分为急性（≤21天）、亚急性（22-90天）和慢性（>90天）三组，评估组织质量、失败率及至少2年随访的临床结局。关键发现：手术延迟与组织质量恶化（P=0.79~0.06）或失败风险增加（P=0.57）无显著相关；总体失败率10.1%，三组间无差异（…
英文摘要
PURPOSE: To determine the association between surgical delay, anterior cruciate ligament (ACL) tissue quality, failure rates, and clinical outcomes at a minimum 2-year follow-up after arthroscopic ACL primary repair (ACLPR). METHODS: Consecutive patients with complete, proximal (type I/II) ACL tears who underwent arthroscopic ACLPR and had a minimum 2-year follow-up were included. Surgical delay was stratified into 3 categories: acute (≤21 days), subacute (22-90 days), and chronic (>90 days). Intraoperative tissue quality was assessed according to synovial sheath integrity (grade 1, completely intact; grade 2, >50% intact; grade 3, <50% intact) and rupture pattern (1-bundle, 2-bundle, and complex tear). Failure was defined as instrumented laxity >3 mm anterior tibial translation side-to-side difference, pivot shift grade ≥2, and/or subjective instability. Clinical and patient-reported outcomes were compared and Patient Acceptable Symptom State thresholds established. RESULTS: Between 2008 and 2021, 276 of 298 (loss to follow-up, 7.4%) patients (mean age, 39.7 ± 10.7 years; females, 50.3%) who underwent ACLPR with a follow-up of 2.9 ± 1.0 years (2.0-6.5 years) met the inclusion criteria. Sixty-eight (24.6%) ACLPR were acute, 152 (50.1%) subacute, and 56 (20.3%) chronic. Surgical delay was not significantly correlated with worse tissue quality (grade 2, P = .79; grade 3, P = .06) or increased failure risk (P = .57). ACLPR failure occurred in 28 patients (10.1%), with no significant differences among groups (acute, 10.2%; subacute, 11.2%; chronic, 7.1%; P = .76). Reoperation rates (P = .62) and anterior tibial translation side-to-side difference (P = .90), as well as patient-reported outcomes (all P > .28) and Patient Acceptable Symptom State threshold achievements (overall: International Knee Documentation Committee, 84.7%; Lysholm, 83.3%; Forgotten Joint Score-12, 87.3%; and ACL-Return to Sport after Injury, 88.5%) were comparable across groups (all P > .05). CONCLUSIONS: Injury chronicity did not adversely affect failure rates or clinical outcomes at minimum 2-year follow-up after ACLPR. Therefore, in the case of a proximal tear location and sufficient tissue quality, surgical delay alone should not be considered a contraindication for ACLPR. LEVEL OF EVIDENCE: Level III, retrospective comparative case series.