Increased risk of ACL revision with non-surgical treatment of a concomitant medial collateral ligament injury: a study on 19,457 patients from the Swedish National Knee Ligament Registry.
Eleonor Svantesson, Eric Hamrin Senorski, Eduard Alentorn-Geli, Olof Westin, David Sundemo, Alberto Grassi, Svemir Čustović, Kristian Samuelsson
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引用次数: 91
Abstract
Purpose: To determine how concomitant medial collateral ligament (MCL) and lateral collateral ligament (LCL) injuries affect outcome after anterior cruciate ligament (ACL) reconstruction.
Methods: Patients aged > 15 years who were registered in the Swedish National Knee Ligament Registry for primary ACL reconstruction between 2005 and 2016 were eligible for inclusion. Patients with a concomitant MCL or LCL injury were stratified according to collateral ligament treatment (non-surgical, repair or reconstruction), and one isolated ACL reconstruction group was created. The outcomes were ACL revision and the 2-year Knee Injury and Osteoarthritis Outcome Score (KOOS), which were analyzed using univariable and multivariable Cox regression and an analysis of covariance, respectively.
Results: A total of 19,457 patients (mean age 27.9 years, 59.4% males) met the inclusion criteria. An isolated ACL reconstruction implied a lower risk of ACL revision compared with presence of a non-surgically treated MCL injury (HR = 0.61 [95% CI 0.41-0.89], p = 0.0097) but not compared with MCL repair or reconstruction. A concomitant LCL injury did not impact the risk of ACL revision. Patients with a concomitant MCL or LCL injury reported inferior 2-year KOOS compared with isolated ACL reconstruction. The largest difference was found in the sports and recreation subscale across all groups, with MCL reconstruction resulting in the maximum difference (14.1 points [95% CI 4.3-23.9], p = 0.005).
Conclusion: Non-surgical treatment of a concomitant MCL injury in the setting of an ACL reconstruction may increase the risk of ACL revision. However, surgical treatment of the MCL injury was associated with a worse two-year patient-reported knee function. A concomitant LCL injury does not impact the risk of ACL revision compared with an isolated ACL reconstruction.
目的:探讨前交叉韧带(ACL)重建术后并发内侧副韧带(MCL)和外侧副韧带(LCL)损伤对预后的影响。方法:2005年至2016年期间在瑞典国家膝关节登记处登记的原发性ACL重建的年龄> 15岁的患者符合纳入条件。根据副韧带治疗(非手术、修复或重建)对合并MCL或LCL损伤的患者进行分层，并建立一个孤立的ACL重建组。结果为ACL翻修和2年膝关节损伤和骨关节炎结局评分(oos)，分别使用单变量和多变量Cox回归和协方差分析进行分析。结果:共有19457例患者符合纳入标准，平均年龄27.9岁，男性59.4%。与非手术治疗的MCL损伤相比，孤立的ACL重建意味着ACL翻修的风险更低(HR = 0.61 [95% CI 0.41-0.89]， p = 0.0097)，但与MCL修复或重建相比则不然。合并LCL损伤不影响ACL翻修的风险。与孤立ACL重建相比，合并MCL或LCL损伤的患者报告的2年kos较低。所有组的运动和娱乐亚量表差异最大，MCL重建导致最大差异(14.1点[95% CI 4.3-23.9]， p = 0.005)。结论:在ACL重建的情况下，非手术治疗合并的MCL损伤可能会增加ACL翻修的风险。然而，手术治疗MCL损伤与两年内患者报告的较差的膝关节功能相关。与孤立的ACL重建相比，合并LCL损伤不会影响ACL翻修的风险。证据等级:队列研究，III级。
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