Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up
Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up
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DOI：
10.1111/j.1600-0838.2006.00547.x
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发表时间：
2007-06-01
影响因子：
4.1
通讯作者：
Good, L.
中科院分区：
文献类型：
--
作者：
Meunier, A.;Odensten, M.;Good, L.
我们研究了100例前交叉韧带（ACL）断裂患者随机分配接受初次修复（加固或非加固）或非手术治疗15年后的长期结局。两组的主观结局相似，活动水平和膝关节损伤及骨关节炎结局评分无差异，但非手术治疗组的Lysholm评分略低。这种差异归因于更多的不稳定症状。放射学骨关节炎（OA）的频率在手术或非手术治疗的患者之间没有差异，但如果进行ACL切除术，无论ACL的初始治疗如何，三分之二的患者显示OA变化。在最初接受非手术治疗的患者中，半月板损伤明显更多。非手术治疗组中有三分之一的患者因不稳定问题接受了二次ACL重建。在这项研究中，ACL修复本身不能降低OA的风险，也不能增加主观结局评分。然而，三分之一的非手术治疗的患者后来ACL重建由于不稳定。研究发现，骨关节炎的状态是发生骨关节炎的最重要预测因素。早期ACL修复和ACL重建可以降低继发性半月板撕裂的风险。这间接地支持了ACL损伤后膝关节早期稳定有利于长期结局的假设。
We investigated the long-term outcome of 100 patients 15 years after having been randomly allocated to primary repair (augmented or non-augmented) or non-surgical treatment of an anterior cruciate ligament (ACL) rupture. The subjective outcome was similar between the groups, with no difference regarding activity level and knee-injury and osteoarthritis outcome score but with a slightly lower Lysholm score for the non-surgically treated group. This difference was attributed to more instability symptoms. The radiological osteoarthritis (OA) frequency did not differ between surgically or non-surgically treated patients, but if a meniscectomy was performed, two-thirds of the patients showed OA changes regardless of initial treatment of the ACL. There were significantly more meniscus injuries in patients initially treated non-surgically. One-third of the patients in the non-surgically treated group underwent secondary ACL reconstruction due to instability problems. In this study, ACL repair itself could not reduce the risk of OA nor increase the subjective outcome scores. However, one-third of the non-surgical treated patients were later ACL reconstructed due to instability. The status of the menisci was found to be the most important predictor of developing OA. Early ACL repair and also ACL reconstruction can reduce the risk of secondary meniscus tears. Indirectly this supports the hypothesis that early stabilization of the knee after ACL injury is advantageous for the long-term outcome.