急性近端前交叉韧带撕裂初次修复术：术后至少2年随访显示高重返运动率及10%失败率
简介
本研究回顾性分析了2018至2023年间123例急性近端ACL撕裂患者（120例完成至少2年随访，平均47.9个月），均于伤后15天内行关节镜下ACL初次修复术（部分联合外侧关节外手术）。关键发现：总体失败率为10%（联合外侧手术组为8.5%），失败患者更年轻（平均22.3岁 vs 32.9岁）且运动水平更高。除外失败病例，95.4%重返运动，79.6%恢复…
英文摘要
PURPOSE: To evaluate the clinical outcomes after arthroscopic primary anterior cruciate ligament (ACL) repair, with and without lateral extra-articular procedures, at a minimum of 2 years follow-up. METHODS: A retrospective case series of prospectively collected data was conducted on patients operated between 2018 and 2023. Consecutive patients with acute proximal ACL tears underwent arthroscopic primary repair within 15 days of injury when intraoperative reducibility and good tissue quality (Sherman I-II) were confirmed. Patients with anterolateral lesions or high-risk received a concomitant lateral extra-articular procedure (anterolateral structure repair, Segond fixation, or Coker-Arnold tenodesis). Outcomes included International Knee Documentation Committee subjective score, Lysholm score, Knee injury and Osteoarthritis Outcome Score, ACL-return to sports after injury score, Forgotten Joint Score-12, Tegner, and side-to-side laxity; analyses assessed group comparisons and associations with failure and return to sport (RTS). RESULTS: Of 123 patients receiving ACL primary repair, 120 completed the 24 months-minimum follow-up (mean 47.9 ± 12.8 months; range 25-82). The overall failure rate was 10%. Among the 106 patients treated with combined ACL primary repair and a lateral extra-articular procedure, 9 (8.5%) experienced failure. Patients who had ACL repair failure were significantly younger (mean age, 22.3 vs 32.9) and more active. RTS was achieved in 95.4% of patients excluding failures, with 79.6% returning to preinjury or higher Tegner activity scale levels. Successful RTS was associated with older age, lower side-to-side laxity, and higher ACL-return to sports after injury and Knee injury and Osteoarthritis Outcome-Sport scores. Regarding patient-reported outcome measures, 69.6% achieved patient-acceptable symptom state for International Knee Documentation Committee, 84.8% for ACL-return to sports after injury, and 69.6% for Forgotten Joint Score-12. The mean side-to-side laxity was 1.6 ± 1.2 mm. The secondary surgery rate (excluding failures) was 11.6%, with most involving contralateral ACL injuries. CONCLUSIONS: Arthroscopic primary ACL repair led to high RTS rates, 10% failure rate, and satisfactory patient-reported outcome measures at a minimum 2-year follow-up. Outcomes were significantly influenced by age and activity level, with higher failure risk in younger and more active patients. LEVEL OF EVIDENCE: Level IV, retrospective case series.