<br>多次修正 ACL 重建后的失败率和并发症：Over-the-Top 和运输钻孔技术的比较。,Orthopaedic Journal of Sports Medicine

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多次修正 ACL 重建后的失败率和并发症：Over-the-Top 和运输钻孔技术的比较。
Orthopaedic Journal of Sports Medicine ( IF 2.4 ) Pub Date : 2023-07-31 , DOI: 10.1177/23259671231186972
Emre Anil Özbek _{1,

2} , Philipp W Winkler _{3,

4} , Ehab M Nazzal ₁ , Bálint Zsidai _{1,

5} , Nicholas P Drain ₁ , Janina Kaarre _{1,

5} , Andrew Sprague ₆ , Bryson P Lesniak ₁ , Volker Musahl ₁

Affiliation

背景多次翻修前交叉韧带重建 (ACLR) 存在一些技术挑战，通常是由于残留硬件、隧道加宽、错位或分期手术造成的。目的比较因 ACLR 翻修失败而接受手术的患者采用 Over-the-top (OTT) 和运输钻孔 (TD) 技术的失败率和并发症率。研究设计队列研究；证据级别，3。方法对使用 OTT 或 TD 技术进行至少 2 次 ACLR 修订的患者的医疗记录进行回顾性审查。收集有关患者人口统计、移植特征、翻修次数、伴随手术、并发症和失败的数据。连续变量和分类变量的组间比较分别采用独立样本 t 检验和 Fisher 精确检验或卡方检验进行。结果共有 101 名接受 OTT（n = 37，37%）和 TD（n = 64，63%）技术多次翻修 ACLR 的患者纳入分析。平均随访时间为 60 个月（范围：12-196 个月）。各组之间的年龄、性别、体重指数、偏侧性或随访时间没有显着差异 (P > .05)。同种异体移植物是最常用的移植物（n = 64；67.3%），各组之间的移植物直径没有显着差异（P > .05）。在同时进行内侧和外侧半月板、软骨或外侧关节外手术的比率方面，各组之间没有统计学上的显着差异（P > .05）。并发症发生率（OTT：n = 2 [5.4%]；TD：n = 8 [13%]）或移植失败率（OTT：n = 4 [11%]；TD： n = 14 [22%]）（两者 P > .05）。结论这项研究的结果表明，在挑战多次修订 ACLR 时，失败率和并发症率明显较高。各种技术的并发症和失败率相似，这表明 OTT 技术是一种有价值的替代方案，可用于修订 ACLR，特别是当单阶段 TD 技术不可能时作为单阶段方法。

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Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-the-Top and Transportal Drilling Techniques.

Background Multiple-revision anterior cruciate ligament reconstruction (ACLR) presents several technical challenges, often due to residual hardware, tunnel widening, malposition, or staged surgeries. Purpose To compare failure and complication rates between the over-the-top (OTT) and transportal drilling (TD) techniques in patients undergoing surgery for failed revision ACLR. Study Design Cohort study; Level of evidence, 3. Methods The medical records of patients with at least 2 revision ACLRs using either the OTT or TD technique were reviewed retrospectively. Data on patient demographics, graft characteristics, number of revisions, concomitant procedures, complications, and failures were collected. Between-group comparisons of continuous and categorical variables were conducted with the independent-samples t test and the Fisher exact or chi-square test, respectively. Results A total of 101 patients undergoing multiple-revision ACLR with OTT (n = 37, 37%) and TD (n = 64, 63%) techniques were included for analysis. The mean follow-up time was 60 months (range, 12-196 months). There were no significant differences in age, sex, body mass index, laterality, or follow-up length between groups (P > .05). Allograft was the graft used most frequently (n = 64; 67.3%) with no significant differences between groups in graft diameter (P > .05). There were no statistically significant differences between groups regarding rate of concurrent medial and lateral meniscus, cartilage, or lateral extra-articular procedures (P > .05). There was also no significant66 between-group difference in complication rate (OTT: n = 2 [5.4%]; TD: n = 8 [13%]) or graft failure rate (OTT: n = 4 [11%]; TD: n = 14 [22%]) (P > .05 for both). Conclusion The results of this study showed notably high failure and complication rates in challenging multiple-revision ACLR. Complication and failure rates were similar between techniques, demonstrating that the OTT technique is a valuable alternative that can be used in a revision ACLR, particularly as a single-stage approach when the single-stage TD technique is not possible.

更新日期：2023-07-31

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