在伴有内侧副韧带损伤的前交叉韧带重建患者中，早期手术干预比延迟治疗效果更好

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.asmr.2024.101038

Blake M. Bacevich B.S. , Sean Hazzard P.A., M.B.A. , Mia Lustig B.S. , Saoirse Connelly B.S. , Varun Nukala B.S. , Peter Asnis M.D.

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All patients underwent ACLR with either bone-tendon-bone autograft or bone-tendon-bone allograft. Patient-reported outcomes (International Knee Documentation Committee [IKDC] score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score [KOOS]) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted.</div></div><div><h3>Results</h3><div>A total of 253 eligible patients with 2-year outcomes were enrolled. Patients with combined ACL-MCL injuries had lower IKDC scores (β = –6.1 vs β = –8.3, <em>P</em> = .003), KOOS Quality of Life values (β = –9.3 vs β = –11, <em>P</em> = .004), and KOOS Sport values (β = –12 vs β = –13, <em>P</em> = .08) if surgery was performed more than 6 weeks after the index injury. Patients with isolated ACL injuries showed lower KOOS Activities of Daily Living values (β = –2.4, <em>P</em> = .045) if surgery was performed at between 3 and 6 months. 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引用次数: 0

摘要

目的探讨前交叉韧带（ACL）重建（ACLR）的时间对患者报告的结果的影响，比较合并和未合并内侧副韧带（MCL）损伤的患者。方法本研究纳入2015年9月至2020年10月期间接受ACLR的患者。纳入标准包括术前和术后患者报告的结果可测量的患者，随访期至少2年。将2级或3级MCL损伤合并前交叉韧带撕裂的患者与无MCL损伤的患者进行比较作为对照。所有患者均行自体骨-肌腱-骨移植或同种异体骨-肌腱-骨移植行ACLR。记录患者报告的结局（国际膝关节文献委员会[IKDC]评分、Lysholm评分、膝关节损伤和骨关节炎结局评分[oos]），并按性别和指数损伤时间对结局进行分析。采用分层线性混合效应回归分析。结果共纳入253例符合条件的2年预后患者。合并ACL-MCL损伤患者的IKDC评分（β = -6.1 vs β = -8.3, P = 0.003）、kos生活质量值（β = -9.3 vs β = -11, P = 0.004）和kos运动值（β = -12 vs β = -13, P = 0.08）如果在指数损伤后6周以上进行手术，则较低。如果在3 - 6个月间进行手术，孤立性前交叉韧带损伤患者的kos日常生活活动值较低（β = -2.4, P = 0.045）。在合并ACL-MCL损伤的患者中，自体移植物的IKDC评分更差(β = -11[95%可信区间（CI）， -18至-4.2]；P = .002), Lysholm分数(β= -9.2(95%可信区间,-15 - -3.1);P = 0.004)， kos生活质量值(β = -11 [95% CI， -20至-1.6]；P = 0),三星疼痛值(β= -5.1(95%可信区间,-10 - -0.03);P = 0.049)， kos症状值(β = -7.6 [95% CI， -10至-0.03]；P = .02)， kos运动值(β = -21 [95% CI， -32至-10]；P & lt;.001)。结论：2级或3级MCL损伤的ACLR患者如果在损伤后6周内进行手术，患者报告的预后得到改善。在这个队列中，与自体移植相比，同种异体移植的预后评分更高。证据水平：III级，回顾性队列研究。

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Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury

Purpose

To investigate the influence of the timing of anterior cruciate ligament (ACL) reconstruction (ACLR) on patient-reported outcomes, comparing patients with and without concomitant medial collateral ligament (MCL) injury.

Methods

This study included patients who underwent ACLR between September 2015 and October 2020. The inclusion criteria included patients for whom preoperative and postoperative patient-reported outcome measures were available and a follow-up period of at least 2 years. Patients who sustained grade 2 or 3 MCL injuries with ACL tears were compared with patients with no MCL injuries as a control. All patients underwent ACLR with either bone-tendon-bone autograft or bone-tendon-bone allograft. Patient-reported outcomes (International Knee Documentation Committee [IKDC] score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score [KOOS]) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted.

Results

A total of 253 eligible patients with 2-year outcomes were enrolled. Patients with combined ACL-MCL injuries had lower IKDC scores (β = –6.1 vs β = –8.3, P = .003), KOOS Quality of Life values (β = –9.3 vs β = –11, P = .004), and KOOS Sport values (β = –12 vs β = –13, P = .08) if surgery was performed more than 6 weeks after the index injury. Patients with isolated ACL injuries showed lower KOOS Activities of Daily Living values (β = –2.4, P = .045) if surgery was performed at between 3 and 6 months. Among patients with combined ACL-MCL injuries, autograft was found to have worse IKDC scores (β = –11 [95% confidence interval (CI), –18 to –4.2]; P = .002), Lysholm scores (β = –9.2 [95% CI, –15 to –3.1]; P = .004), KOOS Quality of Life values (β = –11 [95% CI, –20 to –1.6]; P = .023), KOOS Pain values (β = –5.1 [95% CI, –10 to –0.03]; P = .049), KOOS Symptoms values (β = –7.6 [95% CI, –10 to –0.03]; P = .02), and KOOS Sport values (β = –21 [95% CI, –32 to –10]; P < .001) than allograft.

Conclusions

Patients undergoing ACLR with grade 2 or 3 MCL injuries have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts.