Minimum Two-Year Follow-up of Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity
Minimum Two-Year Follow-up of Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity
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DOI：
10.2106/jbjs.17.00767
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发表时间：
2018-02-21
影响因子：
5.3
通讯作者：
Jung, Min
中科院分区：
文献类型：
--
作者：
Kim, Sung-Jae;Choi, Chong Hyuk;Jung, Min
背景资料：本研究的目的是比较结果的前交叉韧带（ACL）重建患者与广义关节松弛和那些没有它，并探讨影响广义关节松弛对ACL重建的结果从2至8年postoperatives.Methods：我们回顾性分析了163例患者谁经历了单侧ACL重建从2001年1月至2008年12月。根据是否存在全身关节松弛将患者分为2组。比较ACL切除术、移植物断裂和对侧ACL断裂的患者比例。使用Kaplan-Meier分析比较破裂率。采用KT-2000关节测量仪对Lachman试验、平移试验和前平移进行评价。比较Lysholm膝关节评分和国际膝关节文献委员会（IKDC）主观评分。同时评价IKDC客观分级和影像学分级。随访评估进行了2，5，和8年postoperatives.Results：在整个评估期间，广泛的关节松弛的患者中的ACL切除术，移植物断裂，对侧ACL断裂的比例高于没有广泛的关节松弛的患者。然而，比例和累积破裂率的差异没有达到显著性（p > 0.05）。在8年随访时，与无关节松弛的患者相比，关节松弛患者的稳定性较差，功能结局较差。关于Lachman试验和前向平移，在整个评价期间，全身关节松弛患者的结果比无全身关节松弛患者差。在5年（p = 0.002）和8年（p = 0.007）时，显著性偏移检验的结果存在显著差异。在整个评价期间，全身关节松弛患者的Lysholm膝关节评分和IKDC主观评分也较差;这些差异可能不具有临床意义。在每个患者组中，在2年、5年和8年随访时测量的系列结果之间的比较表明，前向平移（p = 0.002），Lysholm膝关节评分（p = 0.014）和IKDC主观评分（p = 0.002）随着时间的推移而恶化，尽管8年时的值与5年时的值相似，但在全身关节松弛患者中。广泛性关节松弛作为患者的固有生理特征，与随访2 - 8年的患者ACL重建的稳定性和功能结局的显著不良影响相关。广泛的关节松弛应被认为是ACL重建术后不良结局的一个风险因素。
Background: The purposes of this investigation were to compare outcomes of anterior cruciate ligament (ACL) reconstruction between patients with generalized joint laxity and those without it and to investigate the effect of generalized joint laxity on outcomes of ACL reconstruction from 2 to 8 years postoperatively.Methods: We retrospectively reviewed 163 patients who had undergone unilateral ACL reconstruction from January 2001 to December 2008. Patients were divided into 2 groups according to presence or absence of generalized joint laxity. The proportions of patients with meniscectomy, graft rupture, and contralateral ACL rupture were compared. Rupture rates were compared with Kaplan-Meier analysis. The Lachman test, pivot-shift test, and anterior translation measured with the KT-2000 arthrometer were evaluated. The Lysholm knee score and International Knee Documentation Committee (IKDC) subjective score were compared. The IKDC objective grade and radiographic grade were also evaluated. Follow-up assessments were performed at 2, 5, and 8 years postoperatively.Results: The proportions of meniscectomy, graft rupture, and contralateral ACL rupture in patients with generalized joint laxity were higher than in patients without generalized joint laxity during the whole evaluation period. However, differences in proportions and cumulative rupture rates did not reach significance (p > 0.05). Patients with generalized joint laxity had less stability and poorer functional outcomes at the 8-year follow-up compared with patients without generalized joint laxity. With regard to the Lachman test and anterior translation, poorer results were shown in patients with generalized joint laxity than in patients without generalized joint laxity during the whole evaluation period. The results of pivot-shift testing differed significantly at 5 years (p = 0.002) and 8 years (p = 0.007). Patients with generalized joint laxity also had worse Lysholm knee scores and IKDC subjective scores during the whole evaluation period; these differences may not be clinically important. Comparisons between serial outcomesmeasured at 2, 5, and 8-year follow-ups within each patient group showed that anterior translation (p = 0.002), Lysholm knee score (p = 0.014), and IKDC subjective score (p = 0.002) deteriorated over time, although the values at 8 years were similar to those at 5 years, in patients with generalized joint laxity.Conclusions: Generalized joint laxity as an inherent physiologic characteristic of patients was related to a significant adverse effect on stability and functional outcomes of ACL reconstruction for patients followed for 2 to 8 years. Generalized joint laxity should be considered a risk factor for poor outcomes after ACL reconstruction.