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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Risk Factors and Predictors Of Subsequent ACL Injury After ACL Reconstruction: Prospective Analysis Of 2801 Primary ACL Reconstructions
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Risk Factors and Predictors Of Subsequent ACL Injury After ACL Reconstruction: Prospective Analysis Of 2801 Primary ACL Reconstructions

机译：ACL重建后继发性ACL损伤的危险因素和预测因素：2801原发性ACL重建的前瞻性分析

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Objectives: Retear of an ACL after an ACL reconstruction (ACLR) is devastating for all involved. Understanding risk factors and predictors of subsequent ACL tear after an ACLR is vital for patient education of subsequent risk of injury and if a predictor is modifiable, to make adjustments to minimize the risk of repeat ACL tear. The objectives of this study were 1) to identify the risk factors and predictors for ispilateral and contralateral ACL tears after primary ACLR and 2) to compare retear risk between the 2002/03 and 2007/08 cohorts. This is the largest and most comprehensive prospective analysis of this kind in the literature. Methods: Data from the 2002-2008 MOON database was used to identify risk factors for ACL retear. Subjects who had a primary ACLR with no history of contralateral knee surgery and had 2 year follow-up data were included. Subjects who had multiligament surgery were excluded. Graft type (auto-BTB, auto-hamstring, allograft), age, Marx score at time of index surgery, sport played post ACLR, sex, smoking status, lateral meniscus tear at the time of ACLR, medial meniscus tear at the time of ACLR, BMI, and MOON site were evaluated to determine their contribution to both ipsilateral retear and contralateral ACL tear. The analysis was repeated using the 2002/3 and 2007/8 cohort and included age, graft, sex, and Marx. An ANOVA with post-hoc analysis was performed to detect significant differences in age and Marx score by graft type over time. Results: A total of 2801 subjects met all inclusion/exclusion criteria. There were 165/2801 (5.89%) ipsilateral and 177/2801 (6.32%) contralateral ACL tears identified in the cohort at the two year follow-up. The odds of ipsilateral retear are 1.68 times greater for hamstring autograft (p=0.04) and 4.67 times greater for an allograft (p<0.001) compared to auto-BTB. The odds of ipsilateral retear decrease by 8% for every yearly increase in age (p < 0.001) and increases by 6% for every increased point on the Marx score (p = 0.017). The odds of contralateral ACL tear increase by 7% for every increased point on the Marx score (p = 0.004) and decreases by 5% for every one point increase in BMI (p = 0.03). In 2002/3, there were 61/815 (7.5%) retears compared to 37/1056 (3.5%) in 2007/8. The odds of retear by for the 2002/03 and 2007/08 cohorts are summarized in table 1. The mean age (figure 1) of subjects receiving BTB and hamstring remained constant over time whereas the mean age of subjects receiving allograft rose by seven years (p < 0.001). Hamstring use was a predictor of retear compared to BTB in the 02/03 group (7.9% vs. 4.2%), but not in the 07/08 group (4.1% vs. 3.4%). Conclusion: Age, activity, and graft type were predictors of increased risk of ipsilateral graft failure after ACLR. Higher activity and lower BMI were found to be risk factors in contralateral ACL tears. Allograft use in young active patients was shown to be a risk factor for graft retear in the 02/03 group, subsequent to this, graft choice changed to using allografts in older and less active patients with an associated decrease in graft retear risk in the 07/08 group. The contralateral ACL injury risk did not change from the early group to the later group. The risk of ACL graft retear was lower for all graft types in the 07/08 group compared to the 02/03 group. The relative decrease risk in hamstring autografts compared to BTB in 07/08 compared to 02/03 may be due to improved surgical techniques, rehabilitation, and/or slower return to play guidelines, and bears further investigation.
机译：目标：ACL重建（ACLR）后对ACL的所有人员都具有毁灭性的破坏。了解ACLR后继发性ACL撕裂的危险因素和预测因素对于患者进行后续受伤风险的教育至关重要，如果预测因素是可修改的，则进行调整以最大程度地减少重复性ACL撕裂的风险。这项研究的目的是1）识别原发性ACLR后患侧和对侧ACL撕裂的危险因素和预测因素，以及2）比较2002/03年和2007/08年队列中的后遗风险。这是文献中此类研究中最大，最全面的前瞻性分析。方法：使用2002-2008 MOON数据库中的数据来确定ACL复发的危险因素。包括没有进行对侧膝关节手术史的原发性ACLR且有2年随访数据的受试者。排除了进行多韧带手术的受试者。移植类型（自动BTB，自动-绳肌，同种异体移植），年龄，分度手术时的马克思评分，ACLR后进行的运动，性别，吸烟状况，ACLR时外侧半月板撕裂，评估ACLR，BMI和MOON部位，以确定它们对同侧后方和对侧ACL撕裂的贡献。使用2002/3和2007/8队列进行了重复分析，包括年龄，嫁接，性别和马克思。进行了事后分析的方差分析，以检测随时间推移移植物类型的年龄和马克思评分的显着差异。结果：共有2801名受试者符合所有纳入/排除标准。在两年的随访中，队列中发现了165/2801（5.89％）同侧和177/2801（6.32％）对侧ACL撕裂。与自体BTB相比，绳肌自体移植（p = 0.04）和同种异体移植（p <0.001）的同侧后退几率分别高1.68倍和4.67倍。年龄的每增加一次，同侧后退的几率降低8％（p <0.001），而马克思得分每增加一个点，同侧后移的几率增加6％（p = 0.017）。对侧ACL撕裂的几率在Marx评分上每升高1个百分点（p = 0.004），而在BMI每升高1个百分点（p = 0.03）则降低5％。在2002/3年度，有61/815（7.5％）的后退，而在2007/8年度有37/1056（3.5％）。表1总结了2002/03和2007/08队列研究的后遗率。随着时间的流逝，接受BTB和绳肌的受试者的平均年龄（图1）保持不变，而接受同种异体移植的受试者的平均年龄上升了七年。 （p <0.001）。与02/03组中的BTB相比，使用string绳肌是可预后的预测指标（7.9％vs. 4.2％），但在07/08组中则不这样（4.1％vs. 3.4％）。结论：年龄，活动和移植物类型是ACLR后同侧移植物失败风险增加的预测因素。发现较高的活动量和较低的BMI是对侧ACL泪液的危险因素。在02/03组中，在年轻活跃患者中使用同种异体移植物是导致移植后排的危险因素，此后，在07年以后，对于年龄较大，活动较少的患者，选择同种异体移植物会导致移植物后移风险的降低。 / 08组。对侧ACL损伤风险从早期组到晚期组没有变化。与02/03组相比，07/08组中所有类型的移植物进行ACL移植后排的风险均较低。与02/03相比，07/08相比BTB，绳肌自体移植的相对降低风险可能归因于手术技术的改进，康复和/或较慢的恢复玩法指南，并且有待进一步研究。

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