使用骨-髌腱-骨自体移植物进行前交叉韧带重建，同时进行外侧韧带半月板切除术或软骨成形术，与无外侧病变相比，不会导致运动和活动恢复能力下降

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-06-01 DOI:10.1016/j.asmr.2024.100910

Sean Hazzard P.A., M.B.A., Saoirse Connolly B.S., Brendan Fitzgerald B.S., Peter Asnis M.D.

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引用次数: 0

摘要

目的探讨外侧半月板和软骨病变对参与枢轴运动的患者前交叉韧带（ACL）重建术后疗效的影响。方法使用单个外科医生的患者登记册，对使用骨-髌腱-骨自体移植进行前交叉韧带重建术（ACLR）的患者进行评估，并使用Marx、Tegner、Lysholm和国际膝关节文献委员会的量表评估患者报告的至少2年疗效。患者被分为三组：孤立的前交叉韧带手术组、前交叉韧带重建加外侧半月板部分切除术组、前交叉韧带重建加外侧半月板部分切除术加外侧软骨成形术组。以孤立的前交叉韧带重建组为对照，我们发现，1年后接受部分外侧半月板切除术的患者马克思评分更高（P = .016）。单纯前交叉韧带组与前交叉韧带加部分外侧半月板切除术和软骨成形术组之间没有明显差异。在半月板部分切除术组中，我们将红白区撕裂患者与白白区撕裂患者进行了比较，发现与单纯前交叉韧带对照组相比没有明显差异。使用国际膝关节文献委员会（International Knee Documentation Committee）、Lysholm 和 Tegner 量表评估各组间的差异也不明显。结论使用骨-髌腱-骨自体移植物和前内侧门户钻孔技术进行前交叉韧带重建与同时进行部分外侧半月板切除术和/或外侧室软骨成形术的患者相比，在恢复活动能力和患者报告结果方面没有任何明显的短期（2 年结果）差异。额外的部分外侧半月板切除术在术后1年和2年显示出明显更高的马克思评分。

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Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft With Lateral Compartment Meniscectomy or Chondroplasty Does Not Lead to Decreased Return to Sport and Activity Compared With No Lateral Pathology

Purpose

To investigate the influence of lateral meniscal and cartilage pathology on the outcome after anterior cruciate ligament (ACL) reconstruction in patients who participate in pivoting sports.

Methods

Using a single-surgeon patient registry, patients undergoing an anterior cruciate ligament reconstruction (ACLR) using bone–patellar tendon–bone autograft were evaluated with minimum 2-year patient reported outcomes evaluated using Marx, Tegner, Lysholm, and International Knee Documentation Committee scales. Patients were divided into 3 groups: isolated ACL surgery, ACLR with a partial lateral meniscectomy, or a ACLR with partial lateral meniscectomy and lateral compartment chondroplasty.

Results

A total of 98 patients met inclusion criteria. Using the isolated ACL reconstruction group as a control, we found that Marx scores were greater in patients who additionally underwent a partial lateral meniscectomy at 1 year (P = .016). There were no significant differences between the ACL-only group and the ACL with partial lateral meniscectomy and chondroplasty group. Within the partial meniscectomy cohort comparing the patients with red-white zone tears with the patients with white-white zone tear, we found there were no significant differences when compared with the ACL-only control. There were no significant differences appreciated between groups using the International Knee Documentation Committee, Lysholm, and Tegner scales.

Conclusions

ACL reconstruction using bone–patellar tendon–bone autograft with anteromedial portal drilling technique does not have any significant short-term (2-year outcome) differences in return to activity and patient-reported outcomes compared with if patients additionally have a partial lateral meniscectomy and/or lateral compartment chondroplasty. Additional partial lateral meniscectomy showed significantly greater Marx scores at 1 and 2 years’ postoperatively.