Long-term outcomes of anterior cruciate ligament reconstruction surgery: 2020 OREF clinical research award paper.
Long-term outcomes of anterior cruciate ligament reconstruction surgery: 2020 OREF clinical research award paper.
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DOI：
10.1002/jor.24794
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Badger GJ
中科院分区：
文献类型：
--
作者：
Fleming BC;Fadale PD;Hulstyn MJ;Shalvoy RM;Tung GA;Badger GJ
尽管进行了 ACL 重建 (ACLR) 手术，但 ACL 损伤仍使膝盖面临创伤后骨关节炎 (PTOA) 的风险。初始移植物张力被认为是影响 PTOA 风险的一个参数。这项随机对照试验 (RCT) 旨在比较两种移植物张力方案之间的结果，这两种方案涵盖了常用的范围。术后 7 年，我们确定两个张力组之间的大多数结果没有显着差异，它们优于未受伤的匹配对照组，并且相对于对照组，两组的 PTOA 都在进展。试验数据库还被用来深入了解 ACL 损伤后 PTOA 的机制。我们确定受伤时的炎症反应破坏了关节的润滑机制之一。我们了解到，与对照组相比，患者在受伤后 5 年仍能在跳跃枢轴活动期间继续保护他们的手术膝关节。我们还确定，术前膝关节功能和心理健康与有症状的 PTOA 相关，存在与不良结果相关的特定解剖学因素，并且接受自体腘绳肌腱移植的患者不会因隧道加宽而导致结果发生变化。我们还验证了 MRI 技术，可以无创地评估移植物强度。总之，随机对照试验确定初始移植物张力不会对 7 年结果产生重大影响。因此，外科医生可以使用移植物张紧方案重建 ACL，该方案在本次随机对照试验中评估的两种移植物张紧技术的范围内。
ACL injuries place the knee at risk for post-traumatic osteoarthritis (PTOA) despite surgical ACL reconstruction (ACLR). One parameter thought to affect PTOA risk is the initial graft tension. This randomized controlled trial (RCT) was designed to compare outcomes between two graft tensioning protocols that bracket the range commonly used. At 7-years post-surgery, we determined that most outcomes between the two tension groups were not significantly different, that they were inferior to an uninjured matched control group, and that PTOA was progressing in the both groups relative to controls. The trial database was also leveraged to gain insight into mechanisms of PTOA following ACL injury. We determined that the inflammatory response at the time of injury undermines one of the joint’s lubricating mechanisms. We learned that patients continue to protect their surgical knee 5 years post-injury compared to controls during a jump-pivot activity. We also established that pre-surgical knee function and mental health were correlated with symptomatic PTOA, that there were specific anatomical factors associated with poor outcomes, and that there were no changes in outcomes due to tunnel widening in patients receiving hamstring tendon autografts. We also validated an MRI technique to non-invasively assess graft strength. In conclusion, the RCT determined that initial graft tensioning does not have a major influence on 7-year outcomes. Therefore, surgeons can reconstruct the ACL using a graft tensioning protocol that is within the window of the two graft tensioning techniques evaluated in this RCT.
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DOI：
10.1177/0363546517739605
发表时间：
2018-03
期刊：
The American journal of sports medicine
影响因子：
--
作者：
Kumar D;Su F;Wu D;Pedoia V;Heitkamp L;Ma CB;Souza RB;Li X
通讯作者：
Li X
影响因子：
7
作者：
Haslauer, C. M.;Elsaid, K. A.;Fleming, B. C.;Proffen, B. L.;Johnson, V. M.;Murray, M. M.
通讯作者：
Murray, M. M.
影响因子：
2.8
作者：
Coats-Thomas, Margaret S.;Miranda, Daniel L.;Fleming, Braden C.
通讯作者：
Fleming, Braden C.
影响因子：
4.8
作者：
Biercevicz, Alison M.;Miranda, Daniel L.;Fleming, Braden C.
通讯作者：
Fleming, Braden C.
DOI：
10.1002/jor.22434
发表时间：
2014-01
期刊：
Journal of orthopaedic research : official publication of the Orthopaedic Research Society
影响因子：
--
作者：
Beynnon BD;Vacek PM;Sturnick DR;Holterman LA;Gardner-Morse M;Tourville TW;Smith HC;Slauterbeck JR;Johnson RJ;Shultz SJ
通讯作者：
Shultz SJ