Incidence and Outcome After Revision Anterior Cruciate Ligament Reconstruction Results From the Danish Registry for Knee Ligament Reconstructions
Incidence and Outcome After Revision Anterior Cruciate Ligament Reconstruction Results From the Danish Registry for Knee Ligament Reconstructions
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DOI：
10.1177/0363546512446000
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发表时间：
2012-07-01
影响因子：
4.8
通讯作者：
Pedersen, Alma B.
中科院分区：
文献类型：
--
作者：
Lind, Martin;Menhert, Frank;Pedersen, Alma B.
背景资料：前交叉韧带（ACL）重建翻修术的描述不多，因为其发生率很低，文献中主要是小病例系列。自2005年以来，丹麦ACL重建登记处一直在监测ACL重建翻修术的发展。假设：我们假设年轻患者的ACL重建翻修术风险高于老年患者，并且ACL重建翻修术后的主观临床结局比初次ACL重建术后更差。研究设计：队列研究;证据等级：2。方法：在丹麦进行ACL重建的所有诊所均向国家ACL重建登记系统报告。计算了2005年至2010年期间初次ACL重建后的翻修率（n = 12，193例手术）和翻修ACL重建后的再次翻修率（n = 1099例手术）。使用膝关节损伤和骨关节炎结局评分（KOOS）、Tegner功能评分和客观膝关节稳定性测量结果报告了翻修队列1年随访的结果。结果：5年后，ACL重建翻修率为4.1%。翻修最常发生在1 - 2年后。初次ACL重建时年龄小于20岁的患者的翻修风险（8.7%）高于年龄大于20岁的患者（2.8%）（校正相对风险，2.58; 95%置信区间，2.02 - 3.30）。ACL翻修重建术后1年的KOOS评分（平均值+/-标准差）为症状73 +/-18，疼痛78 +/-17，日常生活活动84 +/-16，运动52 +/-28，生活质量48 +/-21。所有这些评分均显著低于初次ACL重建：症状评分为77 +/-17，疼痛评分为84 +/-15，日常生活活动评分为89 +/-13，运动评分为62 +/-25，生活质量评分为59 +/-21。膝关节松弛度的侧侧差异从ACL重建翻修前的5.8 mm改善至ACL翻修手术后1年的1.9 mm。使用同种异体移植组织进行翻修手术导致再次翻修的风险高于自体移植组织（相对风险，2.05; 95%置信区间，1.5 - 2.4）（P <0.01）。5年后再翻修率为5.4%。结论：在这项基于人群的观察性研究中，ACL重建的5年翻修率为4.1%。尽管翻修ACL重建术后膝关节稳定性可接受，但主观结局不如初次ACL重建术后。
Background: Revision anterior cruciate ligament (ACL) reconstruction is poorly described because of its rare incidence and mainly small case series presented in the literature. The Danish ACL reconstruction registry has monitored the development in revision ACL reconstruction since 2005.Hypothesis: We hypothesized that younger patients had a higher risk of revision ACL reconstruction than older patients and that subjective clinical outcome was worse after revision ACL reconstruction than after primary ACL reconstruction.Study Design: Cohort study; Level of evidence, 2.Methods: All clinics performing ACL reconstructions in Denmark report to the national ACL reconstruction registry. The revision rate after primary ACL reconstruction (n = 12,193 procedures) and re-revision rate after revision ACL reconstruction (n = 1099 procedures) were calculated for the period of 2005 to 2010. Outcome at 1-year follow-up for the revision cohort was reported using the Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner function score, and objective knee stability measurement.Results: The rate of revision ACL reconstruction was 4.1% after 5 years. Revision occurred most frequently after 1 to 2 years. Patients below 20 years of age at the time of primary ACL reconstruction had a higher risk of revision (8.7%) than did patients older than 20 years of age (2.8%) (adjusted relative risk, 2.58; 95% confidence interval, 2.02-3.30). The KOOS scores 1 year after revision ACL reconstruction (mean +/- standard deviation) were 73 +/- 18 for symptoms, 78 +/- 17 for pain, 84 +/- 16 for activities of daily living, 52 +/- 28 for sports, and 48 +/- 21 for quality of life. All these scores were significantly lower than for primary ACL reconstruction: 77 +/- 17 for symptoms, 84 +/- 15 for pain, 89 +/- 13 for activities of daily living, 62 +/- 25 for sports, and 59 +/- 21 for quality of life. Side-to-side difference in knee laxity improved from 5.8 mm before revision ACL reconstruction to 1.9 mm 1 year after revision ACL surgery. The use of allograft tissue for the revision procedure resulted in a higher risk of re-revision than did autograft tissue (relative risk, 2.05; 95% confidence interval, 1.5-2.4) (P < .01). The rate of re-revision after 5 years was 5.4%.Conclusion: In this observational population-based study, the 5-year revision ACL reconstruction rate was 4.1%. Despite achieving acceptable knee stability after revision ACL reconstruction, subjective outcome is less favorable than after primary ACL reconstruction.