Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study
Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study
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DOI：
10.1007/s00167-011-1501-5
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发表时间：
2011-10-01
影响因子：
3.8
通讯作者：
Thomas, N. P.
中科院分区：
文献类型：
--
作者：
Melton, J. T. K.;Murray, J. R.;Thomas, N. P.
为了研究接受由内而外垂直堆叠褥式缝合修复踝关节撕裂联合前交叉韧带（ACL）重建的患者的长期结局，从ACL重建患者数据库中，确定了1991年至1999年期间接受踝关节修复和ACL重建的连续患者。排除了既往ACL或ACL病变的患者。两个年龄和性别匹配的队列进行了比较，谁经历了联合ACL重建和ACL切除术，谁经历了ACL重建与正常的ACL。结果评分包括尿道修复组的IKDC和Lysholm评分。采用双样本t检验和卡方检验比较IKDC主观评分，最小显著性水平设定为5%（P = 0.05）。接受ACL重建联合踝关节修复的患者的平均IKDC为84.2，而接受踝关节切除术的患者的平均评分为70.5（P = 0.008），踝关节完整的患者的平均评分为88.2（P = 0.005）。86.2%的ACL重建和ACL修复患者的Lysholm评分在80 - 100%之间。实现了69%的后续行动。寿命表法生存分析显示，最佳情况下的10年生存率为89%。本研究表明，ACL重建和ACL修复联合治疗后，患者可获得良好的长期结局，最长可达12年。与ACL重建和ACL切除术相比，可以改善功能评分。作者主张在ACL重建过程中修复腱索撕裂，除非存在复杂撕裂、放射状撕裂或剩余腱索的塑性变形。
To study the long-term outcome of patients who have undergone inside-out, vertical stacked mattress suture repair of meniscal tears combined with anterior cruciate ligament (ACL) reconstruction.From a database of ACL reconstructed patients, consecutive patients undergoing concomitant meniscal repair and ACL reconstruction between 1991 and 1999 were identified. Patients with previous ACL or meniscal pathology were excluded. Two age- and sex-matched cohorts who had undergone combined ACL reconstruction and menisectomy and who had undergone ACL reconstruction with normal menisci were identified for comparison. Outcome scoring included IKDC and Lysholm scores for the meniscal repair group. Two sample t-tests and chi-square tests were used to compare the IKDC subjective scores, with a minimum level of significance set at 5% (P = 0.05).Fourty-four patients were identified for analysis with a median follow-up of 10 years (7.7-12.6). Patients undergoing ACL reconstruction combined with meniscal repair had a mean IKDC of 84.2 compared with a mean score of 70.5 (P = 0.008) in patients who had undergone menisectomy and 88.2 (P = 0.005) in patients with intact menisci. 86.2% of patients with ACL reconstruction and meniscal repair had Lysholm score of between 80 and 100%. Sixty-nine percent follow-up was achieved. Survival analysis by life table method shows a best case of 89% 10-years survival.This study demonstrates that good long-term outcomes can be obtained in patients up to over 12 years after combined ACL reconstruction and meniscal repair. Improved functional scores can be achieved when compared with ACL reconstruction and menisectomy. The authors advocate repair of meniscal tears during ACL reconstruction unless there is complex tearing, radial tearing or plastic deformation of the remaining meniscus.III.