The Swedish National Anterior Cruciate Ligament Register A Report on Baseline Variables and Outcomes of Surgery for Almost 18,000 Patients
The Swedish National Anterior Cruciate Ligament Register A Report on Baseline Variables and Outcomes of Surgery for Almost 18,000 Patients
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DOI：
10.1177/0363546512457348
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发表时间：
2012-10-01
影响因子：
4.8
通讯作者：
Kartus, Juri
中科院分区：
文献类型：
--
作者：
Ahlden, Mattias;Samuelsson, Kristian;Kartus, Juri
背景资料：瑞典国家前交叉韧带登记处提供了一个质量监督和研究的机会。目的：主要目的是在早期阶段识别与不良结局相关的因素。研究设计：病例系列;证据等级，4。方法：使用基于网络的协议进行登记，包括2个部分：一个是基于患者的部分，包括自我报告的结局评分，另一个是基于外科医生的部分，其中包括损伤原因、既往手术、损伤和重建之间的时间、移植物选择、固定技术，并报告了伴随的伤害。自我报告的结果评分注册术前，在1，2，和5 years.Results：大约90%的前交叉韧带（ACL）重建每年在瑞典进行的注册报告。纳入了2005-2010年期间的登记（n = 17，794）。排除多韧带重建和再次手术后，初次手术（n = 15，387）和翻修手术（n = 964）的男性：女性比例为57.5：42.5。受伤的原因是足球在大约一半的男性患者和三分之一的女性患者。在接受初次重建的患者中，术后1年、2年和5年膝关节损伤和骨关节炎结局评分（KOOS）的所有子量表均显著改善。在KOOS方面，在所有随访情况下，翻修明显不如初次重建，吸烟者在术前和2年时的表现明显不如不吸烟者。与无此类损伤的患者相比，在重建时伴有踝关节或软骨损伤的患者在术前和1年时的大多数KOOS分量表中表现明显较差。5年时，仅在运动/娱乐分量表方面存在显著差异。与单束重建相比，双束重建显示2年时所有KOOS分量表无显著差异（114例双束vs 5109例单束）。在5年期间，9.1%（对侧，5.0%;翻修，4.1%）的患者接受了对侧ACL重建或首次膝关节翻修重建。15 ~ 18岁女子足球运动员的相应数字为22.0%。结论：初次ACL重建术显著改善了KOOS的所有分量表。年轻女子足球运动员面临着ACL再损伤或对侧ACL损伤的主要风险; ACL翻修重建的效果不如初次重建，吸烟者不如不吸烟者。
Background: The Swedish National Anterior Cruciate Ligament Register provides an opportunity for quality surveillance and research.Purpose: The primary objective was to recognize factors associated with a poorer outcome at an early stage.Study Design: Case series; Level of evidence, 4.Methods: Registrations are made using a web-based protocol with 2 parts: a patient-based section with self-reported outcome scores and a surgeon-based section, where factors such as cause of injury, previous surgery, time between injury and reconstruction, graft selection, fixation technique, and concomitant injuries are reported. The self-reported outcome scores are registered preoperatively and at 1, 2, and 5 years.Results: Approximately 90% of all anterior cruciate ligament (ACL) reconstructions performed annually in Sweden are reported in the register. Registrations during the period 2005-2010 were included (n = 17,794). After excluding multiligament reconstructions and reoperations, the male: female ratio was 57.5: 42.5 for both primary (n = 15,387) and revision (n = 964) surgery. The cause of injury was soccer in approximately half the male patients and in one third of the female patients. All subscales of the Knee injury and Osteoarthritis Outcome Score (KOOS) were significantly improved 1, 2, and 5 years postoperatively in patients undergoing primary reconstructions. In terms of the KOOS, revisions did significantly less well than primary reconstructions on all follow-up occasions, and smokers fared significantly less well than nonsmokers both preoperatively and at 2 years. Patients who had concomitant meniscal or chondral injuries at reconstruction did significantly less well preoperatively and at 1 year in terms of most KOOS subscales compared with patients with no such injuries. At 5 years, a significant difference was only found in terms of the sport/recreation subscale. Double-bundle reconstructions revealed no significant differences in terms of all the KOOS subscales at 2 years compared with single-bundle reconstructions (114 double-bundle vs 5109 single-bundle). During a 5-year period, 9.1% (contralateral, 5.0%; revision, 4.1%) of the patients underwent a contralateral ACL reconstruction or revision reconstruction of the index knee. The corresponding figure for 15- to 18-year-old female soccer players was 22.0%.Conclusion: Primary ACL reconstruction significantly improves all the subscales of the KOOS. Young female soccer players run a major risk of reinjuring their ACL or injuring the contralateral ACL; revision ACL reconstructions do less well than primary reconstructions, and smokers do less well than nonsmokers.