缝合增强与单纯ACL翻修重建采用全软组织移植物的活动度、重返运动和移植物存活率改善比较
简介
回顾性队列研究比较全软组织移植物翻修ACL重建中缝线增强（arACLR）与单纯翻修（irACLR）的疗效，纳入104例、随访至少2年。缝线增强组术后Tegner评分更高、移植物失败率更低、重返运动率更高，而Lysholm和IKDC评分、并发症及满意度无显著差异；探索性分析显示缝线增强组术后内、外侧及旋转性胫骨前移均更小。提示翻修ACL重建中使用缝线增强可改善…
英文摘要
PURPOSE: To compare clinical outcomes of suture-augmented revision anterior cruciate ligament reconstruction (arACLR) and isolated revision anterior cruciate ligament reconstruction (irACLR) using all-soft-tissue grafts. METHODS: Consecutive patients with clinically diagnosed anterior cruciate ligament reconstruction graft failure at a single institution between January 2020 and January 2023 were retrospectively analyzed. Patients who underwent revision anterior cruciate ligament reconstruction using all-soft-tissue grafts with a minimum 2-year follow-up were included and divided into the irACLR and arACLR groups based on whether suture augmentation was used. Multivariate regression models with inverse probability of treatment weighting were used to compare the treatment modalities with the primary outcome (patient-reported outcome measures) and the secondary outcomes (graft failure, contralateral injury, arthrofibrosis, hardware irritation, return to sport, and satisfaction). Exploratory analyses were performed on passive anterior tibial subluxation (PATS) measured on pre- and postoperative magnetic resonance imaging. RESULTS: A total of 47 patients in the arACLR group and 57 patients in the irACLR group were included. The baseline characteristics were well balanced between the groups after inverse probability of treatment weighting, with no difference in surgical characteristics. In the inverse probability of treatment weighting model, arACLR was associated with a higher postoperative Tegner score compared with irACLR (β, 0.64 [95% confidence interval, 0.06-1.22], P = .031), with no significant difference in Lysholm or International Knee Documentation Committee subjective scores (all P > .05). A higher percentage of patients in the arACLR group met the minimal clinically important difference for the Tegner score as compared with the irACLR group (39/47 vs 34/57, P = .018). arACLR showed a decreased graft failure rate (odds ratio, 0.20 [95% confidence interval, 0.05-0.65], P = .006) and increased return to sport rate (odds ratio, 3.85 [95% confidence interval, 2.09-7.29], P < .001) compared with irACLR, with no significant difference in the rate of contralateral injury, arthrofibrosis, hardware irritation, and satisfaction (all P > .05). Exploratory analyses showed significantly lower postoperative lateral PATS (4.2 ± 3.0 vs 8.3 ± 2.9 mm, P < .001), medial PATS (2.4 ± 2.2 vs 4.7 ± 2.4 mm, P < .001), and rotational PATS (1.8 ± 2.3 vs 3.6 ± 2.4 mm, P = .002) in the arACLR compared with the irACLR group. CONCLUSIONS: arACLR was associated with improved postoperative Tegner score, reduced graft failure rate, and increased return to sport rate compared with irACLR with similar complication and patient satisfaction rate at a minimum of 2-year follow-up. LEVEL OF EVIDENCE: Level III, retrospective cohort study.