Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction
Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction
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DOI：
10.1016/j.arthro.2005.04.110
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发表时间：
2005-08-01
影响因子：
4.7
通讯作者：
Refshauge, K
中科院分区：
文献类型：
--
作者：
Salmon, L;Russell, V;Refshauge, K
目的：本研究的目的是确定使用髌腱或腘绳肌腱自体移植物重建ACL后对侧前交叉韧带（ACL）断裂和ACL移植物断裂的发生率，并确定可能增加这种风险的任何患者特征。研究类型：病例系列。方法：在2年内，对743名患者进行了760次内窥镜ACL重建术。316例采用自体骨-髌腱-骨移植，427例采用4股腘绳肌腱移植。排除了既往对侧ACL断裂或同时接受双侧ACL重建的患者，留下675例膝关节（675例患者）进行审查。不参与首次手术或患者护理的人员通过手术后5年进行的电话访谈进行随访评估。根据国际膝关节文献委员会量表，询问患者ACL移植物断裂、对侧ACL断裂、不稳定或严重损伤症状、ACL损伤家族史和活动水平的发生率。从我们的前瞻性数据库中，我们获得了关于移植物来源、关节面或关节面损伤以及性别的进一步信息。二元逻辑回归用于测量测量变量与移植物断裂和对侧ACL断裂风险之间的相关性。结果：初次ACL重建后5年，675例患者中的612例（90.7%）接受了评估。39例患者（6%）发生ACL移植物断裂，35例患者（6%）发生对侧ACL断裂。3例患者同时发生移植物断裂和对侧ACL损伤。初始损伤的接触机制使ACL移植物断裂的几率增加了3倍。恢复到I级或2级运动会使对侧ACL损伤的风险增加10倍。ACL移植物断裂的风险在重建后的前12个月最大。没有其他研究变量增加ACL重复损伤的风险。结论：重建后，12%的患者在5年以上发生ACL重复损伤。重建十二个月后，ACL移植物的风险并不比对侧ACL更大，这表明此时已经实现了足以进行大多数活动的移植物和肌肉功能。确定的重复ACL损伤的风险因素包括恢复竞争性侧步、旋转或跳跃运动，以及指数损伤的接触机制。女性患者ACL重复损伤的风险并不比男性患者高，移植物的选择并不影响ACL重复损伤的发生率。证据等级：IV级，病例系列。
Purpose: The aim of this study was to determine the rates of contralateral anterior cruciate ligament (ACL) rupture and of ACL graft rupture after ACL reconstruction using either patellar tendon or hamstring tendon autograft, and to identify any patient characteristics that may increase this risk. Type of Study: Case series. Methods: Over a 2-year period, 760 endoscopic ACL reconstructions were performed in 743 patients. Bone-patellar tendon-bone autograft was used in 316 patients and 4-strand hamstring tendon in 427 patients. Those patients with a previous contralateral ACL rupture or those who underwent a simultaneous bilateral ACL reconstruction were excluded, leaving 675 knees (675 patients) for review. Persons not involved in the index operation or the care of the patient conducted follow-up assessment by telephone interview conducted 5 years after surgery. Patients were questioned about the incidence of ACL graft rupture, contralateral ACL rupture, symptoms of instability or significant injury, family history of ACL injury, and activity level according to the International Knee Documentation Committee scale. From our prospective database we obtained further information on graft source, meniscal or articular surface injury, and gender. Binary logistic regression was used to measure the relative association between the measured variables and the risk of graft rupture and contralateral ACL rupture. Results: Five years after primary ACL reconstruction, 612 of the 675 patients (90.7%) were assessed. ACL graft rupture occurred in 39 patients (6%) and contralateral ACL rupture occurred in 35 patients (6%). Three patients suffered both a graft rupture and a contralateral ACL injury. The odds of ACL graft rupture were increased 3-fold by a contact mechanism of initial injury. Return to level I or 2 sports increased the risk of contralateral ACL injury by a factor of 10. The risk of sustaining an ACL graft rupture was greatest in the first 12 months after reconstruction. No other studied variable increased the risk of repeat ACL injury. Conclusions: After reconstruction, repeat ACL injury occurred in 12% of patients over 5 years. Twelve months after reconstruction, the ACL graft is at no greater risk than the contralatral ACL, suggesting that adequate graft and muscular function for most activities is achieved by this time. Risk factors for repeat ACL injury identified included a return to competitive side-stepping, pivoting, or jumping sports, and the contact mechanism of the index injury. Female patients were at no greater risk of repeat ACL injury than male patients and graft choice did not affect the rate of repeat ACL injury. Level of Evidence: Level IV, case series.