Reconstructive versus non-reconstructive treatment of anterior cruciate ligament insufficiency. A retrospective matched-pair long-term follow-up
Reconstructive versus non-reconstructive treatment of anterior cruciate ligament insufficiency. A retrospective matched-pair long-term follow-up
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DOI：
10.1007/s00264-010-1174-6
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发表时间：
2011-04-01
影响因子：
2.7
通讯作者：
Schmitt, Holger
中科院分区：
文献类型：
--
作者：
Streich, Nikolaus A.;Zimmermann, David;Schmitt, Holger
在这个回顾性病例系列中，80名患者被分成40对配对组，经关节镜证实为前交叉韧带功能不全，对其进行了15年的随访。其中一半接受自体BTB膝盖骨移植重建，另一半接受保守的基于物理治疗的康复计划治疗。在随访时，临床评分(Lysholm，IKDC)在接受前交叉韧带重建和未接受前交叉韧带重建的受试者之间没有显著差异。此外，在两个队列之间，骨关节炎的发病率没有明显差异。轴移试验阴性的患者表现出明显较少的放射学骨关节炎迹象和较好的功能评估分数，无论是否重建。基于这些结果和文献回顾，没有明确的证据表明前交叉韧带重建可以降低骨性关节炎的发展速度或改善长期有症状的预后。也许，通过解剖学方法进行重建的回顾将比几十年前的手术技术更成功。
In this retrospective case series 80 patients divided in 40 matched pair groups with an arthroscopically proven ACL insufficiency were followed up for 15 years. One half was reconstructed using an autologous BTB patella graft, the other half was treated by a conservative physiotherapeutic based rehabilitation program. At follow-up the clinical scores (Lysholm, IKDC) showed no significant differences between subjects who had undergone ACL reconstruction and those who had not. Furthermore there was no detectable difference in the incidence of osteoarthritis between the cohorts. Patients having a negative pivot shift test showed significantly less signs of radiographic osteoarthritis and better functional assessment scores whether reconstructed or not. Based on these results and a review of the literature there is no clear evidence that ACL reconstruction reduces the rate of OA development or improves the long-term symptomatic outcome. Probably review of reconstruction by an anatomical approach will be more successful than operative techniques decades ago.