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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Knee Hyperextension as a Predictor of Failure in Revision ACL Reconstruction
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Knee Hyperextension as a Predictor of Failure in Revision ACL Reconstruction

机译：膝关节过度伸展可预测修订ACL重建失败

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Objectives: We studied the minimum 2 year follow-up outcomes in an ACL revision cohort. The hypothesis is that knees that hyperextend will have a worse outcome and greater odds of graft failure than knees that do not hyperextend. The null hypothesis is that there is no difference in outcomes or graft rupture between the two groups. Methods: Revision ACL reconstruction patients were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, surgical technique and pathology, and a series of validated patient reported outcome instruments (IKDC, KOOS, WOMAC, and Marx activity rating score). Patients were followed up for 2 years, and asked to complete the identical set of outcome instruments. A regression model using graft failure as the dependent variable included graft type, age, and hyperextension greater than or equal to 5 degrees yeso (HE) in order to assess these potential surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. Results: There were 1,145 subjects included in the analyses. The median age of the cohort was 26 (IQR= 20, 35), and 58% were male. The proportion that were enrolled for their first revision surgery was 88%, their second 10%, and third or greater 2%. The number of subjects categorized as HE was 375 (33%). The median age of subjects that failed was 18, compared to 26 for those with intact grafts. All three variables included in our regression model were significant predictors of graft failure: younger age, inter-quartile range odds ratio (IQROR) = 3.32 (95%CI 1.5, 7.2) p= 0.002; use of allograft OR = 3.1 (95%CI 1.4, 6.9) p= 0.01, and HE 2.1 (95%CI 1.02, 4.42) p= 0.04. Conclusion: The MARS Study Group has previously reported that young age and the use of allograft as a graft source are independent predictors (over 3X odds ratio) of graft rupture after revision ACLR. This study found that knee hyperextension greater than or equal to 5 degrees is present in 1/3 of patients who undergo revision ACLR. HE is also an independent predictor of graft failure after revision ACLR. This is the first study to investigate and confirm knee physiologic hyperextension as a risk factor (over 2X odds ratio) of graft rupture in ACL surgery. Future reports on ACL reconstruction results should separately evaluate the group of knees that hyperextend 5 degrees or more as compared to those that do not.
机译：目的：我们研究了ACL修订队列中至少2年的随访结果。假设是，与不过度伸展的膝盖相比，过度伸展的膝盖将具有更差的结果和更大的移植失败几率。零假设是两组之间的结果或移植物破裂没有差异。方法：确定并修订了ACL重建患者，并于2006年至2011年期间对其进行了登记。收集的数据包括基线人口统计学，手术技术和病理学，以及一系列经过验证的患者报告的结局指标（IKDC，KOOS，WOMAC和Marx活动评分）。对患者进行了2年的随访，并要求他们完成相同的结果工具集。使用移植物衰竭作为因变量的回归模型包括移植物类型，年龄和大于或等于5度的是/否（HE）过度伸展，以评估修订ACL重建后2年临床结果的这些潜在手术危险因素。结果：分析中包括1,145个受试者。该队列的中位年龄为26岁（IQR = 20，35），其中58％为男性。他们的第一次翻修手术的比例为88％，第二次为10％，第三次或更高为2％。被归类为HE的受试者人数为375（33％）。失败者的中位年龄为18岁，而完整移植者为26岁。我们回归模型中包括的所有三个变量都是移植失败的重要预测指标：年龄较小，四分位间距比（IQROR）= 3.32（95％CI 1.5，7.2）p = 0.002;使用同种异体移植OR = 3.1（95％CI 1.4，6.9）p = 0.01，HE 2.1（95％CI 1.02，4.42）p = 0.04。结论：MARS研究小组先前曾报道，修订版ACLR后，年轻年龄和使用同种异体移植物作为移植物破裂的独立预测因子（3倍优势比）。这项研究发现，接受修订版ACLR的患者中，有1/3大于或等于5度的膝部过度伸展。 HE还是修订ACLR后移植物衰竭的独立预测因子。这是第一个研究并确认膝盖生理过度伸展是ACL手术中移植物破裂的危险因素（超过2倍优势比）的第一项研究。关于ACL重建结果的未来报告应分别评估与没有过度伸展5度或更多度的膝盖相比的膝盖组。

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