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首页> 外文期刊>Journal of orthopaedic research >Long-term outcomes of anterior cruciate ligament reconstruction surgery: 2020 OREF clinical research award paper
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Long-term outcomes of anterior cruciate ligament reconstruction surgery: 2020 OREF clinical research award paper

机译：前十字条纹韧带重建手术的长期结果：2020年厄夫特临床研究裁决

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ACL injuries place the knee at risk for post-traumatic osteoarthritis (PTOA) despite surgical anterior cruciate ligament (ACL) reconstruction. One parameter thought to affect PTOA risk is the initial graft tension. This randomized controlled trial (RCT) was designed to compare outcomes between two graft tensioning protocols that bracket the range commonly used. At 7 years postsurgery, we determined that most outcomes between the two tension groups were not significantly different, that they were inferior to an uninjured matched control group, and that PTOA was progressing in both groups relative to controls. The trial database was also leveraged to gain insight into mechanisms of PTOA following ACL injury. We determined that the inflammatory response at the time of injury undermines one of the joint's lubricating mechanisms. We learned that patients continue to protect their surgical knee 5 years postinjury compared to controls during a jump-pivot activity. We also established that presurgical knee function and mental health were correlated with symptomatic PTOA at 7 years, that there were specific anatomical factors associated with poor outcomes, and that there were no changes in outcomes due to tunnel widening in patients receiving hamstring tendon autografts. We also validated a magnetic resonance imaging technique to noninvasively assess graft strength. In conclusion, the RCT determined that initial graft tensioning does not have a major influence on 7-year outcomes. Therefore, surgeons can reconstruct the ACL using a graft tensioning protocol that is within the window of the two graft tensioning techniques evaluated in this RCT.
机译：尽管进行了前交叉韧带（ACL）重建手术，但ACL损伤仍使膝盖面临创伤后骨关节炎（PTOA）的风险。一个被认为影响PTOA风险的参数是初始移植物张力。这项随机对照试验（RCT）旨在比较两种移植物张力方案之间的结果，这两种方案包含了常用的范围。术后7年，我们确定两组患者的大多数结果没有显著差异，低于未受伤的对照组，两组患者的PTOA均较对照组有所进展。该试验数据库还用于深入了解ACL损伤后PTOA的机制。我们确定损伤时的炎症反应破坏了关节的润滑机制之一。我们了解到，与对照组相比，在跳转活动中，患者在受伤5年后仍能继续保护他们的手术膝盖。我们还确定，术前膝关节功能和心理健康与7岁时的症状性上睑下垂相关，有特定的解剖学因素与不良预后相关，接受自体腘绳肌腱移植的患者，由于隧道扩大，预后没有变化。我们还验证了无创评估移植物强度的磁共振成像技术。总之，RCT确定初始移植物张力对7年预后没有重大影响。因此，外科医生可以在本RCT评估的两种移植物张力技术范围内，使用移植物张力方案重建ACL。

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