Surgical timing of anterior cruciate ligament reconstruction to prevent associated meniscal and cartilage lesions
Surgical timing of anterior cruciate ligament reconstruction to prevent associated meniscal and cartilage lesions
复制标题
DOI：
10.1016/j.jos.2018.02.006
复制
发表时间：
2018-05-01
影响因子：
1.7
通讯作者：
Tanaka, Sakae
中科院分区：
文献类型：
--
作者：
Taketomi, Shuji;Inui, Hiroshi;Tanaka, Sakae
背景：本研究的目的是分析原发性前交叉韧带（ACL）重建患者的半月板和软骨病变患病率与手术时间之间的关系，以确定手术的安全时间。方法：本回顾性研究纳入226例患者，其中女性91例，男性135例，中位年龄29岁。我们回顾了ACL损伤到手术的时间间隔（中位4个月，范围1-420个月）以及ACL重建中伴随的半月板和软骨病变。采用受试者工作特征（ROC）曲线分析确定手术预防半月板或软骨病变的精确阈值间隔。使用比值比（OR）确定每个截止期后病变发生的风险。结果：内侧半月板（MM）、外侧半月板（LM）和软骨病变的发生率分别为43.8%、32.7%和27.4%。ROC分析显示，等待ACL重建超过6个月、4个月和5个月的患者发生MM、LM和软骨病变的风险分别显著增加。损伤后7个月行ACL重建的患者与6个月内行重建的患者相比，MM病变存在的OR为4.1 （p < 0.001）。同样，损伤后>= 5个月行ACL重建的患者与4个月内行重建的患者相比，LM病变存在的OR为1.9 (p = 0.023)，损伤后>= 6个月行ACL重建的患者与6个月内行重建的患者相比，软骨病变存在的OR为2.9 （p < 0.001）。结论：前交叉韧带重建应在损伤后约6个月内进行，以防止相关的半月板或软骨病变。(c) 2018日本骨科协会。Elsevier B.V.版权所有。
Background: The purpose of this study was to analyze the association between the prevalence of meniscal and chondral lesions and the timing of surgery in patients undergoing primary anterior cruciate ligament (ACL) reconstruction to determine a safe time for surgery.Methods: This retrospective study involved 226 patients (91 females and 135 males; median age, 29 years) undergoing primary ACL reconstruction. Time interval from ACL injury to surgery (median, 4 months; range, 1-420 months) and concomitant meniscal and cartilage lesions in ACL reconstruction were reviewed. Receiver operating characteristic (ROC) curve analysis was used to determine the precise threshold interval to surgery to prevent meniscal or cartilage lesions. The risk of lesion occurrence after each cutoff period was determined using odds ratio (OR).Results: The incidences of medial meniscus (MM), lateral meniscus (LM), and cartilage lesions were 43.8%, 32.7%, and 27.4%, respectively. ROC analysis revealed that patients who waited for more than 6, 4, and 5 months for ACL reconstruction had a significantly greater risk of associated MM, LM, and chondral lesions, respectively. Patients who underwent ACL reconstruction >= 7 months after injury had OR of 4.1 (p < 0.001) for the presence of MM lesion as compared with those who underwent reconstruction within 6 months. Similarly, patients who underwent ACL reconstruction >= 5 months after injury had OR of 1.9 (p = 0.023) for the presence of LM lesion as compared with those who underwent reconstruction within 4 months, and patients who underwent ACL reconstruction >= 6 months after injury had OR of 2.9 (p < 0.001) for chondral lesion as compared with those who underwent reconstruction within 6 months.Conclusion: ACL reconstruction should be performed within approximately 6 months after the injury to prevent associated meniscal or chondral lesions. (c) 2018 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.