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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success?
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Anterior Cruciate Ligament Reconstruction With Concomitant Meniscal Repair: Is Graft Choice Predictive of Meniscal Repair Success?

机译：伴随半月板修复的前十字韧带重建：是半月板修复成功的贪污选择吗？

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Background: When meniscal repair is performed during anterior cruciate ligament (ACL) reconstruction (ACLR), the effect of ACL graft type on meniscal repair outcomes is unclear. Hypothesis: The authors hypothesized that meniscal repairs would fail at the lowest rate when concomitant ACLR was performed with bone--patellar tendon--bone (BTB) autograft. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent meniscal repair at primary ACLR were identified from a longitudinal, prospective cohort. Meniscal repair failures, defined as any subsequent surgical procedure addressing the meniscus, were identified. A logistic regression model was built to assess the association of graft type, patient-specific factors, baseline Marx activity rating score, and meniscal repair location (medial or lateral) with repair failure at 6-year follow-up. Results: A total of 646 patients were included. Grafts used included BTB autograft (55.7%), soft tissue autograft (33.9%), and various allografts (10.4%). We identified 101 patients (15.6%) with a documented meniscal repair failure. Failure occurred in 74 of 420 (17.6%) isolated medial meniscal repairs, 15 of 187 (8%) isolated lateral meniscal repairs, and 12 of 39 (30.7%) of combined medial and lateral meniscal repairs. Meniscal repair failure occurred in 13.9% of patients with BTB autografts, 17.4% of patients with soft tissue autografts, and 19.4% of patients with allografts. The odds of failure within 6 years of index surgery were increased more than 2-fold with allograft versus BTB autograft (odds ratio = 2.34 [95% confidence interval, 1.12-4.92]; P = .02). There was a trend toward increased meniscal repair failures with soft tissue versus BTB autografts (odds ratio = 1.41 [95% confidence interval, 0.87-2.30]; P = .17). The odds of failure were 68% higher with medial versus lateral repairs ( P & .001). There was a significant relationship between baseline Marx activity level and the risk of subsequent meniscal repair failure; patients with either very low (0-1 points) or very high (15-16 points) baseline activity levels were at the highest risk ( P = .004). Conclusion: Meniscal repair location (medial vs lateral) and baseline activity level were the main drivers of meniscal repair outcomes. Graft type was ranked third, demonstrating that meniscal repairs performed with allograft were 2.3 times more likely to fail compared with BTB autograft. There was no significant difference in failure rates between BTB versus soft tissue autografts. Registration: NCT00463099 (ClinicalTrials.gov identifier).
机译：背景：当在前令人毛病（ACL）重建（ACLR）期间进行半月板修复时，ACL接枝型对半月板修复结果的影响尚不清楚。假设：作者假设Mensiscal Repair在用骨 - 髌骨肌腱 - 骨（BTB）自体移植物伴随时，Meniscal Repase以最低速率失效。研究设计：队列研究;证据级别，3.方法：从纵向，前瞻性队列中鉴定了原发性ACLR的半月板修复的患者。半月板修复失败，定义为解决半月板的任何后续外科手术。建立了一个逻辑回归模型，以评估移植型，特定因素，基线马克思活动评级得分和半月板修复位置（内侧或横向）的结合，在6年的随访时进行修复失败。结果：共用646名患者。使用的移植物包括BTB自体移植物（55.7％），软组织自体移植物（33.9％）和各种同种异体移植物（10.4％）。我们确定了101名患者（15.6％），并记录了一个有文件的半月板修复失败。失败发生在420（17.6％）中孤立的内侧半月板修复，187（8％）的15个（8％）隔离半月板修复，以及39（30.7％）的组合内侧和横向半月板修理的12个。半月板修复失败发生在13.9％的BTB自体移植患者，17.4％的软组织自体移植患者，19.4％的同种异体移植患者。 6年内未能在指数手术内的失败的几率增加超过2倍，同种异体移植物与BTB自体移植物（差距= 2.34 [95％置信区间，1.12-4.92]; p = .02）。随着软组织而增加了半月板修复失败的趋势与BTB自体移植物（差距= 1.41 [95％置信区间，0.87-2.30]; p = .17）。失败的几率高68％，内侧与侧向维修（P＆amp; .001）更高。基线马克思活动水平与随后的半月板修复失败的风险之间存在显着的关系;非常低（0-1点）或非常高（15-16点）基线活动水平的患者处于最高风险（P = .004）。结论：半月板修复位置（内侧VS横向）和基线活动水平是半月板修复结果的主要驱动因素。与BTB自体移植相比，接枝型排名第三，表明用同种异体移植物进行的半月板维修比较可能更少的可能性。 BTB与软组织自体移植物之间的失效率没有显着差异。注册：NCT00463099（ClinicalTrials.gov标识符）。

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