Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors from a Multicenter Cohort
Subsequent Surgery after Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors from a Multicenter Cohort
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DOI：
10.1177/2325967116s00135
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发表时间：
2016-07-29
影响因子：
2.6
通讯作者：
Group M
中科院分区：
文献类型：
--
作者：
Ding D;Group M
重建前十字韧带(ACL)失败或再损伤可导致复发的不稳定和伴随的关节内损伤。虽然翻修前交叉韧带重建术(RACLR)可以恢复膝关节的稳定性和改善患者的活动水平，但据报道，这些手术的结果不如直接前交叉韧带重建术。RACLR后的进一步再手术可能会对患者满意度和结果产生更深远的影响。然而，目前缺乏关于rACLR术后继发手术的比率和危险因素的信息。在2006至2011年间，1205名接受rACLR的患者被纳入研究对象，这是一个前瞻性队列。有989人(82%)获得了两年的问卷随访，1112人(92%)获得了电话随访。如果患者报告进行了后续手术，则获得详细说明后续操作的手术报告(S)并对其进行分类。使用重复均值方差分析来显示患者报告结果的显著差异。采用多元回归分析确定再次手术的独立危险因素。122名患者(10.1%)在2年的随访期内共接受了172次同侧膝关节手术。在再次手术中，26.7%为半月板手术(69%为半月板切除，26%为修复)，18.6%为再手术，17.4%为软骨手术(61%为软骨成形术，17%为微骨折手术，13%为马赛克成形术)，10%为硬件切除手术，9.3%为关节纤维化手术，如粘连松解和滑膜切除。在两年的随访中，再次手术的患者的IKDC、Koos症状和疼痛评分以及WOMAC僵硬评分显著降低。多变量分析显示，20岁以下患者再次手术的可能性是20-29岁患者的2.1倍。RACLR时使用同种异体骨移植和分期翻修(rACLR之前的隧道植骨)也是2年内需要再次手术的重要预测因素。在rACLR期间出现IV级软骨损伤的患者在2年内接受后续手术的可能性降低47%。性别、体重指数、吸烟史、马克思活动评分、股骨隧道置入技术、半月板撕裂或半月板治疗对再手术率无显著影响。RACLR术后2年的再手术率为10.1%。最常见的再手术涉及半月板手术。同侧膝关节继发手术的独立危险因素包括年龄和20岁，分期翻修和在rACLR时使用异体移植组织。
Failure or reinjury after anterior cruciate ligament (ACL) reconstruction can lead to recurrent instability and concomitant intra-articular injuries. While revision ACL reconstruction (rACLR) can be performed to restore knee stability and improve patient activity level, outcomes after these surgeries are reported to be inferior to primary ACL reconstruction. Further reoperation after rACLR can have an even more profound effect on patient satisfaction and outcome. Yet, there is a current lack of information regarding the rate and risk factors for subsequent surgery after rACLR. 1205 patients who underwent rACLR were enrolled between 2006 and 2011, comprising the prospective cohort. Two-year questionnaire follow-up was obtained on 989 (82%), while telephone follow-up was obtained on 1112 (92%). If a patient reported having a subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categoriezed. A repeated meaures ANOVA was used to reveal significatnt differences in patient reported outcomes. Multivariate regression analysis was performed to determine independent risk factors for reoperation. One hundred and twenty-two patients (10.1%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperation procedures, 26.7% were meniscus procedures (69% meniscectomy, 26% repair), 18.6% were subsequent rACLR, 17.4% were cartilage procedures (61% chondroplasty, 17% microfracture, and 13% mosaicplasty), 10% hardware removal, and 9.3% were procedures for arthrofibrosis such has lysis of adhesions and synovectomy. Patients who had reoperations had significantly lower IKDC, KOOS symptoms and pain scores, and WOMAC stiffness scores at two-year follow up. Multivariate analysis revealed that patients under 20 years old were 2.1 times more likely than patients aged 20-29 to have a reoperation. Use of allograft at the time of rACLR and staged revision (bone grafting of tunnels before rACLR) were also significant predictors for need for reoperation within 2 years. Patients with grade IV cartilage damage seen during rACLR were 47% less likely to undergo subsequent operations within 2 years. Gender, BMI, smoking history, Marx activity score, technique for femoral tunnel placement and meniscal tear or meniscal treatment at the time of rACLR showed no significant effect on reoperation rate. There is a significant reoperation rate following rACLR at two years (10.1%). The most prevalent reoperations involved meniscal procedures. Independent risk factors for subsequent surgery on the ipsilateral knee include age<20 years old, a staged revision and use of allograft tissue at the time of rACLR.