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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Meniscal Repair with Concurrent Anterior Cruciate Ligament Reconstruction: Operative Success and Patient Outcomes at 6-Year Follow-up
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Meniscal Repair with Concurrent Anterior Cruciate Ligament Reconstruction: Operative Success and Patient Outcomes at 6-Year Follow-up

机译：半月板修复并发前交叉韧带重建：6年随访的手术成功率和患者预后。

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Objectives: Meniscus repairs are commonly performed concurrently with anterior cruciate ligament reconstruction (ACLR) in the acutely injured knee. Properly functioning menisci coupled with knee stability are thought to be critical factors in achieving optimal outcomes. While meniscal repair in conjunction with ACLR has demonstrated good success at 2 years, no large-scale, prospective, multicenter studies have evaluated long-term patient-oriented outcomes after combined ACLR and meniscus repair. We hypothesize that patient-centered outcome scores will deteriorate and ipsilateral reoperations will increase at 6 years following combined ACLR and meniscus repair. Methods: All unilateral primary ACL reconstructions from the Multicenter Orthopaedic Outcomes Network (MOON) between 2002 and 2004 were evaluated, and patients who underwent concurrent meniscus repair were selected. Validated patient-oriented outcome data [Knee Injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities (WOMAC) scores, Marx activity scores and International Knee Documentation Committee (IKDC) scores] was gathered at 2 and 6 years following the index procedure. Subsequent ipsilateral knee re-operation was confirmed by operative reports to evaluate for failure of meniscal repairs. Results: In total, 1440 primary ACLR’s were performed between 2002 and 2004 as part of the study cohort. Of these, 286 subjects underwent concurrent meniscus repair (298 meniscal repairs). 235/286 (82.2%) were available for follow up at 6 years (154 medial meniscus repairs, 72 lateral meniscal repairs, and 9 patients who underwent both lateral and medial meniscal repairs). Overall, the success rate of meniscal repair at the time of ACLR was 86% (202/235) at 6 years. We found an 86.4% six year success rate with combined ACLR and medial meniscal repair, 86.1% for lateral meniscal repairs and 77.8% when both medial and lateral menisci were repaired. 27.3% (9/33) of the failures were associated revision ACL surgery. Medial meniscal repairs failed earlier (mean 2.1 years) than lateral meniscal repairs (mean 3.7 years) (p=0.01). All-inside techniques were performed in 88.5% of cases. There were 31 failures with this technique representing a 14.9% failure rate. There was one failure in the inside-out technique group (1/19, 5.2%), and one failure noted in the outside-in technique group (1/6, 16.6%). Significant improvements were observed in patient reported outcomes [KOOS Symptoms, KOOS Pain, KOOS KRQOL, WOMAC Pain, and IKDC scores] when baseline scores were compared to 6-year follow-up. No significant clinical differences were observed between 2 and 6 year follow up indicating there was no clinical deterioration over this time period. Marx Activity levels gradually declined from time of injury to 6-year follow-up. Conclusion: Concurrent meniscal repair with ACLR is associated with success rates approximating 86% at 6-year follow-up. Patient-oriented outcome measures were generally similar between 2 and 6 years follow up. Surgeons may expect good clinical outcomes 6 years after combined ACLR and meniscus repairs.
机译：目的：半月板修复通常在急性受伤的膝盖中同时进行前交叉韧带重建（ACLR）。正常的半月板功能和膝关节稳定性被认为是获得最佳结果的关键因素。尽管半月板修复与ACLR结合已在2年内取得了良好的成功，但尚无大规模，前瞻性，多中心研究评估ACLR和半月板联合修复后以患者为导向的长期结果。我们假设在以ACLR和半月板联合修复的6年后，以患者为中心的结果评分将恶化，同侧再手术将增加。方法：对2002年至2004年间多中心骨科成果网络（MOON）进行的所有单侧原发性ACL重建进行评估，并选择同时进行半月板修复的患者。在该指标后第2年和第6年收集了经过验证的以患者为中心的结果数据[膝关节损伤和骨关节炎结果评分（KOOS），西安大略省和麦克马斯特大学（WOMAC）评分，马克思活动评分和国际膝关节文献委员会（IKDC）评分]。程序。随后的同侧膝关节再手术被手术报告证实，以评估半月板修复失败。结果：作为研究队列的一部分，在2002年至2004年之间总共进行了1440次主要ACLR。其中，286名受试者同时进行了半月板修复（298次半月板修复）。 235/286（82.2％）患者可在6年后进行随访（154次内侧半月板修复，72次外侧半月板修复和9例同时进行了外侧和内侧半月板修复）。总体而言，ACLR术后6年半月板修复的成功率为86％（202/235）。我们发现ACLR和内侧半月板修复相结合的六年成功率为86.4％，外侧半月板修复为86.1％，内侧半月板和外侧半月板同时修复的成功率为77.8％。 27.3％（9/33）的失败与修订ACL手术相关。内侧半月板修复失败（平均2.1年）比外侧半月板修复失败（平均3.7年）（p = 0.01）。 88.5％的病例采用全内镜技术。使用该技术的故障有31例，故障率达14.9％。从内而外的技术组中有1个失败（1 / 19，5.2％），而从外而内的技术组中有1个失败（1 / 6，16.6％）。当将基线评分与6年随访进行比较时，观察到患者报告的结局[KOOS症状，KOOS疼痛，KOOS KRQOL，WOMAC疼痛和IKDC评分]显着改善。在2年和6年的随访期间未观察到明显的临床差异，表明在这段时间内没有临床恶化。从受伤时间到6年随访，马克思的活动水平逐渐下降。结论：ACLR同时进行半月板修复在6年的随访中成功率约为86％。在2至6年的随访期间，以患者为导向的结局指标通常相似。外用ACLR和半月板修复术后6年，外科医生可能会期望良好的临床结果。

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