ACL重建术中半月板修复率增加未提高再手术风险：2015至2023年手术趋势分析
简介
本研究分析了2015-2023年间2748例ACL重建（ACLR）合并半月板手术的病例，旨在评估半月板手术方式的变化趋势，并比较不同时期（2015-2019 vs. 2020-2023）的再手术率及患者报告结局。结果显示，半月板修复率从18.0%显著上升至30.2%（p<0.001），而半月板切除术比例下降。然而，两个时期的半月板修复再手术率（9.0% vs…
英文摘要
PURPOSE: To evaluate surgical trends over time in meniscal procedures during anterior cruciate ligament reconstruction (ACLR) and compare meniscal reoperation rates and subjective outcomes between 2015-2019 and 2020-2023. METHODS: This study included 2748 knees undergoing primary ACLR with concomitant meniscal procedures at Capio Artro Clinic, Stockholm, Sweden, stratified by time period (2015-2019 vs. 2020-2023). Meniscal reoperations within two years were identified through medical records, Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at two years for patients undergoing meniscal repair. Minimal important change (MIC), patient-acceptable symptom state (PASS) and treatment failure (TF) were assessed through KOOS4. Subgroup analysis compared reoperation rates following medial, lateral and combined medial and lateral meniscal procedures. RESULTS: The proportion of meniscal repairs increased (18.0%-30.2%, p < 0.001), whereas meniscal resections decreased (21.1%-15.1%, both p < 0.001) from 2015-2019 to 2020-2023. Meniscal reoperation rates did not differ significantly between cohorts for repairs (9.0% vs. 11.4%, p = not significant (n.s.)) or resections (5.0% vs. 3.9%, p = n.s.). Combined medial and lateral meniscal procedures had significantly higher meniscal reoperation rates overall (11.7%) compared to medial (6.5%) and lateral (7.8%) meniscal procedures (p < 0.001). Lateral meniscal resections resulted in significantly more reoperations (2.8%) compared to medial (1.4%) and combined (1.5%) meniscal resections (p = 0.04) within the full cohort. There were no significant differences between cohorts in MIC, PASS, or TF. Multivariable analysis showed lower odds of reoperation in 2020-2023 compared to 2015-2019 (odds ratio [OR] = 0.39; 95% confidence interval [CI] 0.26-0.60; p < 0.001). CONCLUSION: Meniscal repair rates during ACLR increased significantly over time, while short-term reoperation rates and patient-reported outcomes remained unchanged. These findings align with the increasing emphasis on meniscal preservation in clinical practice. LEVEL OF EVIDENCE: Level III.