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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Internal Brace ACL Repair is Associated with High Failure Rate in the First Two Years Post-Surgery
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Internal Brace ACL Repair is Associated with High Failure Rate in the First Two Years Post-Surgery

机译：术后两年内，内部支撑ACL修复与高失败率相关

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Objectives: To compare graft/internal brace survival, self-reported functional outcomes, and joint laxity in adolescents who underwent quadriceps tendon patellar autograft (QPA) reconstruction versus ACL repair with internal brace ligament augmentation. Methods: We identified all adolescent and pediatric subjects who underwent primary ACL reconstruction or repair with internal brace augmentation between January 2013 and January 2016. Only subjects with a minimum of 6 months of follow-up were included. Graft failure, range of motion (ROM), complications, and demographic information including age and gender was collected. Failure was defined as the need for revision surgery or MRI-confirmed graft/internal brace failure. Subjects were prospectively contacted by telephone and were invited to either schedule a follow-up appointment or to complete research questionnaires over the phone. Objective joint laxity measures, KT1000, were obtained from a subset of subjects (N=25 QPA and N=6 repair group) that completed the research visit. Wilcoxon rank sum tests were used to compare IKDC and joint laxity measure. Multi-variable Cox proportional hazards regression analyses were used to compare failure-free survival in the two groups during the first 24 months post-surgery. Results: The final cohort included 132 patients in the QPA group (52% female) and 19 patients in the repair group (53% female). The repair group tended to be younger (mean: 14.1 yrs, ±2.9 vs 15.5 yrs, ±1.8). Median duration of follow-up was 2.1 years [range: 0.5-4 years] in the repair group compared to 1.2 years [range: 0.5-4 years] in the QPA group. Within the first 24 months post-surgery, the cumulative incidence of failure was 3.8% (5/132) in the QPA group compared to 52.6% (10/19) in the repair group. After adjusting for age, the hazard of failure in the repair group was 22.1 [95% CI: 6.7 to 73.2, p <0.0001] times the hazard of failure in the QPA group. KT-1000 side-to-side joint laxity measures in the repair group [Median: 2.5 mm, range: -1 mm to 7 mm] were significantly [p=0.0212] higher than the joint laxity measures in the QPA group [Median: 1.0 mm, range: -1 mm to 4 mm]. There was no difference [p= 0.3826] in IKDC scores in the repair group [N=53, median: 97, range: 58-100] compared to the QPA group [N=10, median: 94, range: 32-100]. Conclusion: Failure rate and joint laxity measures were significantly increased in the internal brace repair group relative to the QPA group. Failure-free survival in the repair group was less than 50% at two years.The high failure rate in the repair group should be considered when selecting the appropriate intervention for the pediatric adolescent athlete with an ACL injury.
机译：目的：比较接受股四头肌腱pa骨自体移植（QPA）重建与ACL内支架韧带增强修复的青少年的移植物/内部支架存活，自我报告的功能结局和关节松弛。方法：我们确定了所有在2013年1月至2016年1月之间进行了初次ACL重建或内支架固定修复的青少年和小儿科目。仅包括至少随访6个月的科目。收集了移植失败，活动范围（ROM），并发症以及包括年龄和性别在内的人口统计信息。失败定义为需要翻修手术或经MRI确认的移植物/内支架失败。前瞻性地通过电话联系受试者，并邀请他们安排随访预约或通过电话填写研究问卷。从完成研究访问的部分受试者（N = 25 QPA和N = 6修复组）中获得客观的关节松弛度KT1000。使用Wilcoxon秩和检验比较IKDC和关节松弛度。使用多变量Cox比例风险回归分析来比较两组在术后头24个月内的无衰竭生存率。结果：最终队列包括QPA组的132例患者（女性52％）和修复组的19例（女性53％）。修复组往往更年轻（平均：14.1岁，±2.9比15.5岁，±1.8）。修复组的中位随访时间为2。1年[范围：0。5-4年]，而QPA组为1。2年[范围：0。5-4年]。在手术后的头24个月内，QPA组的失败累积发生率为3.8％（5/132），而修复组为52.6％（10/19）。调整年龄后，修复组的失败风险是QPA组的失败风险的22.1 [95％CI：6.7至73.2，p <0.0001]倍。修复组[中位数：2.5 mm，范围：-1 mm至7 mm]中的KT-1000左右关节松弛度措施[Q = 0.0212]显着高于QPA组[中位数： 1.0毫米，范围：-1毫米至4毫米]。与QPA组[N = 10，中位数：94，范围：32-100]相比，修复组[N = 53，中位数：97，范围：58-100]的IKDC评分没有差异[p = 0.3826] ]。结论：相对于QPA组，内支架修复组的失败率和关节松弛措施明显增加。修复组两年内无故障生存率低于50％。为患有ACL损伤的儿童青少年运动员选择适当的干预措施时，应考虑修复组的高失败率。

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