首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study
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Clinical and Functional Outcomes of Anterior Cruciate Ligament Reconstruction at a Minimum of 2 Years Using Adjustable Suspensory Fixation in Both the Femur and Tibia: A Prospective Study

机译:在股骨和胫骨中使用可调式悬吊固定至少2年进行前交叉韧带重建的临床和功能结果:一项前瞻性研究

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Background: The success of anterior cruciate ligament (ACL) reconstruction requires reliable and rigid graft fixation. Cortical suspensory fixation (CSF) devices have become an acceptable alternative to interference screws for soft tissue ACL grafts. However, CSF devices have been reported to be associated with tunnel widening and increased postoperative anterior laxity compared with interference screw fixation. Adjustable CSF devices were introduced to avoid these problems but have been associated with graft lengthening and inconsistent outcomes. Purpose: To (1) report the side-to-side difference (SSD) in anterior laxity at 150 N, clinical scores, and failure rates 2 years after ACL reconstruction with 4-strand semitendinosus autografts using an adjustable CSF device and (2) determine the preoperative factors associated with clinical outcomes. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 131 patients who had undergone primary ACL reconstruction, performed with 4-strand semitendinosus grafts that were secured using Pullup adjustable-length CSF devices with femoral and tibial fixation techniques, were prospectively enrolled in this study; 34 patients were excluded because of contralateral instability or ipsilateral knee injuries that required additional surgery. This left a cohort of 97 patients who were evaluated preoperatively and at 6, 12, and 24 months. The evaluation consisted of measuring the SSD in anterior laxity and patient-reported outcome scores (International Knee Documentation Committee [IKDC] and Lysholm scores). Regression analyses were performed to determine associations between these outcomes and 9 preoperative variables. Results: Only 2 patients could not be reached, 2 could not be evaluated because of contralateral ACL tears, and 2 had graft failure. At 2-year follow-up, the remaining 91 patients had a mean SSD in anterior laxity of 0.8 ± 1.8 mm (range, –4.2 to 5.3 mm), mean IKDC score of 87.6 ± 10.6 (range, 43.7-100.0), and mean Lysholm score of 90.8 ± 9.3 (range, 56.0-100.0). At final follow-up, compared with knees with partial ruptures, those with complete ruptures had equivalent laxity ( P = .266) and Lysholm scores ( P = .352) but lower IKDC scores ( P = .009). Multivariable regression revealed that the IKDC score decreased with increased preoperative laxity (β = –1.35 [95% CI, –2.48 to –0.23]; P = .019). Conclusion: The novel adjustable-length CSF device produced satisfactory anterior laxity and clinical outcomes, with a failure rate of 2.1%, which compare favorably with those reported for nonadjustable CSF devices.
机译:背景:前交叉韧带(ACL)重建的成功需要可靠且牢固的移植物固定。皮质悬吊固定(CSF)设备已成为软组织ACL移植物的干扰螺钉的可接受替代方案。然而,据报道,与干扰螺钉固定相比,CSF装置与隧道拓宽和术后前松弛度增加有关。引入了可调节的CSF装置来避免这些问题,但与移植物延长和结果不一致有关。目的:(1)报告使用可调节的CSF装置进行4线半腱肌自体移植重建ACL后2年,在150 N时前松弛的侧面差异(SSD),临床评分和失败率,以及(2)确定与临床结果相关的术前因素。研究设计:病例对照研究;证据级别,3级。方法:前瞻性纳入了131例接受初次ACL重建的患者,这些患者均采用4股半腱肌移植物进行了手术,这些移植物使用了具有股骨和胫骨固定技术的Pullup可调长度CSF装置固定。 ;由于对侧不稳或同侧膝关节损伤需要额外的手术,因此将34例患者排除在外。剩下的97名患者在术前,6、12和24个月接受了评估。评估包括测量SSD的前松弛度和患者报告的结局评分(国际膝关节文献委员会[IKDC]和Lysholm评分)。进行回归分析以确定这些结果与9个术前变量之间的关联。结果:只有2例患者无法到达,2例因对侧ACL撕裂而无法评估,2例发生移植失败。在2年的随访中,其余91例患者的前松弛度SSD平均为0.8±1.8 mm(范围–4.2至5.3 mm),IKDC平均得分为87.6±10.6(范围43.7-100.0),并且平均Lysholm评分为90.8±9.3(范围56.0-100.0)。在最终的随访中,与部分破裂的膝盖相比,完全破裂的膝盖具有同等的松弛度(P = .266)和Lysholm评分(P = .352),但IKDC评分较低(P = .009)。多变量回归显示,IKDC评分随着术前松弛度的增加而降低(β= –1.35 [95%CI,–2.48至–0.23]; P = .019)。结论:新型可调节长度的CSF装置产生了令人满意的前松弛度和临床结局,失败率为2.1%,与报道的不可调节的CSF装置相比具有优势。

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