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{"title":"[Early Surgical Treatment Options for Anterior Cruciate Ligament Injury].","authors":"Filip Hušek, Roman Mizera, Lukáš Čapek, Zdeněk Horák","doi":"10.55095/achot2024/055","DOIUrl":null,"url":null,"abstract":"<p><p>Anterior cruciate ligament (ACL) is one of the most commonly injured structures in distortion injuries of the knee joint. Currently, there is no consensus among the professional community regarding the basic principles and timing of ACL injury management. An analysis of several retrospective studies from the 2008-2023 period provides information on ACL preservation procedures and a comparison of these results with those of ACL reconstruction surgery using a graft. The most comprehensive information was provided by a large meta-analysis conducted by Van der List et al. in 2019, which compared 1101 patients from 13 studies who had undergone an ACL preservation surgery. Wilson et al. carried out a retrospective study of patients who underwent ACL repair with InternalBrace (Arthrex© implant system) ligament augmentation. In their meta-analysis, Van der List et al. reported the failure rate of 7-11% and the functional outcome score > 85% of maximum scores in the scoring systems used (Lysholm, KOOS, IKDC score) for the preservation procedures. Wilson et al. in their retrospective study reported the failure rate of 10.4% and the functional outcome > 87% of maximum scores in the scoring systems used. These values are consistent with similar outcomes reported in patients undergoing ACL reconstruction surgery using a graft. According to the available literature, the primary ACL refixation with InternalBrace augmentation for proximal ruptures appears to be a safe technique with satisfactory outcomes when properly timed and indicated. In acute proximal ruptures, this technique should be considered as an alternative to ACL reconstruction using a graft, with potential benefits of preserving the original tissue and proprioception of the ligament. A prospective randomized study which would compare these two surgical techniques is still lacking in the literature.</p>","PeriodicalId":6980,"journal":{"name":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","volume":"92 1","pages":"45-51"},"PeriodicalIF":0.4000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.55095/achot2024/055","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
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Abstract
Anterior cruciate ligament (ACL) is one of the most commonly injured structures in distortion injuries of the knee joint. Currently, there is no consensus among the professional community regarding the basic principles and timing of ACL injury management. An analysis of several retrospective studies from the 2008-2023 period provides information on ACL preservation procedures and a comparison of these results with those of ACL reconstruction surgery using a graft. The most comprehensive information was provided by a large meta-analysis conducted by Van der List et al. in 2019, which compared 1101 patients from 13 studies who had undergone an ACL preservation surgery. Wilson et al. carried out a retrospective study of patients who underwent ACL repair with InternalBrace (Arthrex© implant system) ligament augmentation. In their meta-analysis, Van der List et al. reported the failure rate of 7-11% and the functional outcome score > 85% of maximum scores in the scoring systems used (Lysholm, KOOS, IKDC score) for the preservation procedures. Wilson et al. in their retrospective study reported the failure rate of 10.4% and the functional outcome > 87% of maximum scores in the scoring systems used. These values are consistent with similar outcomes reported in patients undergoing ACL reconstruction surgery using a graft. According to the available literature, the primary ACL refixation with InternalBrace augmentation for proximal ruptures appears to be a safe technique with satisfactory outcomes when properly timed and indicated. In acute proximal ruptures, this technique should be considered as an alternative to ACL reconstruction using a graft, with potential benefits of preserving the original tissue and proprioception of the ligament. A prospective randomized study which would compare these two surgical techniques is still lacking in the literature.
[前交叉韧带损伤的早期手术治疗选择]。
前交叉韧带(ACL)是膝关节畸变损伤中最常见的损伤结构之一。目前,对于前交叉韧带损伤处理的基本原则和时机,专业医学界尚未达成共识。对2008-2023年期间的几项回顾性研究的分析提供了ACL保存方法的信息,并将这些结果与使用移植物重建ACL手术的结果进行了比较。Van der List等人在2019年进行的一项大型荟萃分析提供了最全面的信息,该分析比较了13项研究中接受ACL保留手术的1101名患者。Wilson等人对采用InternalBrace (Arthrex©implant system)韧带增强术修复前交叉韧带的患者进行了回顾性研究。在他们的荟萃分析中,Van der List等人报道了失败率为7-11%,功能结局评分为bb0 - 85%,是用于保存程序的评分系统(Lysholm, oos, IKDC评分)的最高分。Wilson等人在他们的回顾性研究中报道,在所使用的评分系统中,失败率为10.4%,功能预后为0.07%。这些值与报道的使用移植物进行ACL重建手术的患者的类似结果一致。根据现有的文献,在适当的时间和指示下,采用内支增强术治疗近端骨折是一种安全的技术,效果令人满意。在急性近端骨折中,该技术应被视为使用移植物重建前交叉韧带的替代方法,具有保留原始组织和韧带本体感觉的潜在好处。比较这两种手术技术的前瞻性随机研究在文献中仍然缺乏。
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