Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting.
Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting.
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隧道植骨与非隧道植骨翻修前交叉韧带重建术患者的描述性特征和结果。
DOI：
10.1177/03635465221104470
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发表时间：
2022-07
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在前交叉韧带（ACL）重建翻修手术中，可能需要对溶解或错位的隧道进行植骨。患者特征以及移植对ACL重建翻修术（rACLR）后结局的影响尚未得到充分描述。描述接受植骨手术的rACLR患者与未接受植骨手术的rACLR患者的术前特征、术中发现和2年结局。队列研究，证据等级3 2006年至2011年前瞻性入组了1234例接受rACLR的患者。收集基线翻修和2年人口统计学、手术技术、病理学、治疗和患者报告结局工具（IKDC、KOOS、WOMAC、马克思活动评分），以及后续手术信息（如适用）。使用卡方和ANOVA统计分析比较组特征。159例受试者（13%）接受了隧道移植：64例（5%）接受了一期移植，95例（8%）接受了二期移植。在31例（2.5%）受试者中，移植物单独植入股骨，40例（3%）植入胫骨，88例（7%）合并植入。两阶段组的基线KOOS生活质量（QOL）和马克思活动评分显著低于未植骨组（p<0.001）。与未植骨组相比，需要二期移植的患者既往ACL重建次数更多（p<0.001），并且在初次ACLR手术中接受BTB或软组织自体移植的可能性更低（p≤0.02）。对于当前的rACLR，与未植骨组相比，接受一期或二期植骨的患者更有可能接受BTB同种异体移植物（p≤0.008），而不太可能接受软组织自体移植物（p≤0.003）。对1052例（85%）受试者进行的2年随访发现，与未进行植骨相比，2期植骨组（IDKC、KOOS QOL、体育娱乐和马克思活动）的结局较差（p≤0.01）。单期植骨组与无植骨组相比无显著差异。在我们的rACLR队列中，13%进行了隧道植骨，8%进行了2期手术。与未接受植骨的患者相比，接受2期植骨治疗的患者的基线和2年患者报告结局和活动水平较差。与未接受骨移植的患者相比，接受一期移植治疗的患者具有相似的基线和2年患者报告的结局和活动水平。大型多中心研究发现，与不需要移植的患者相比，二期骨移植可能导致ACL翻修手术的2年结局较差。#ACL #膝关节#手术#MARS #研究#翻修#骨移植#隧道
Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament (ACL) reconstruction surgery. Patient characteristics, and impact of grafting on outcomes following revision ACL reconstruction (rACLR) are not well described. Describe preoperative characteristics, intraoperative findings, and 2-year outcomes for rACLR patients undergoing bone grafting procedures compared to rACLR patients without grafting. Cohort Study, Level of Evidence 3 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year demographics, surgical technique, pathology, treatment, and patient-reported outcome instruments (IKDC, KOOS, WOMAC, Marx activity score) were collected, as well as subsequent surgery information, if applicable. Group characteristics were compared using chi-squared and ANOVA statistical analyses. 159 subjects (13%) underwent tunnel grafting: 64 (5%) underwent single-stage and 95 (8%) underwent two-stage grafting. Grafting was isolated to the femur in 31 (2.5%) subjects, tibia in 40 (3%), and combined in 88 (7%). Baseline KOOS quality-of-life (QOL) and Marx activity scores were significantly lower in the two-stage compared to the no bone grafting group (p<0.001). Patients who required 2-stage grafting had more prior ACL reconstructions (p<0.001) and were less likely to have received BTB or soft tissue autograft at primary ACLR procedure (p≤0.02) compared to the no bone grafting group. For current rACLR, patients undergoing either 1 or 2-stage bone grafting were more likely to receive BTB allograft (p≤0.008) and less likely to receive a soft tissue autograft (p≤0.003) compared to the no bone grafting group. Two-year follow-up on 1052 (85%) subjects found inferior outcomes in the 2-stage bone graft group (IDKC, KOOS QOL, sports recreation, and Marx activity) compared to no bone grafting (p≤0.01). The single-stage bone graft group did not significantly differ compared to the no bone grafting group. Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-staged surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared to patients not undergoing bone grafting. Patients treated with single-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared to patients not undergoing bone grafting. Large multi-center study finds that two stage bone grafting may lead to inferior 2-year outcomes in revision ACL surgery compared to patients who don’t require grafting. #ACL #knee #surgery #MARS #research #revision #bone grafting #tunnels
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DOI：
10.1053/jars.2001.21509
发表时间：
2001-02-01
影响因子：
4.7
作者：
Fink, C;Zapp, M;Rieger, M
通讯作者：
Rieger, M
影响因子：
4.8
作者：
FAHEY, M;INDELICATO, PA
通讯作者：
INDELICATO, PA
DOI：
10.1016/j.knee.2018.08.003
发表时间：
2018-12
期刊：
The Knee
影响因子：
--
作者：
DeFroda SF;Karamchedu NP;Owens BD;Bokshan SL;Sullivan K;Fadale PD;Hulstyn MJ;Shalvoy RM;Badger GJ;Fleming BC
通讯作者：
Fleming BC
DOI：
10.1111/j.2517-6161.1995.tb02031.x
发表时间：
1995-01-01
影响因子：
5.8
作者：
BENJAMINI, Y;HOCHBERG, Y
通讯作者：
HOCHBERG, Y
影响因子：
4.8
作者：
Battaglia, Michael J.;Cordasco, Frank A.;Warren, Russell F.
通讯作者：
Warren, Russell F.