Background:The potential influence of a preoperative anterolateral ligament (ALL) lesion seen on magnetic resonance imaging (MRI) on the mid- and long-term surgical outcomes of anterior cruciate ligament (ACL) reconstruction is still controversial.Purpose:To evaluate the clinical outcomes and failure rate of isolated ACL reconstruction at a minimum 5-year follow-up in patients with and without ALL injury diagnosed preoperatively using MRI.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (control group) of ALL injury on preoperative MRI. This is a longer-term follow-up study of a previously published study that had a minimum 2-year follow-up. Both groups underwent anatomic isolated reconstruction of the ACL. The Lysholm and subjective International Knee Documentation Committee scores, KT-1000 arthrometer and pivot-shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. The evaluation at the 5-year follow-up was also compared with the same patient’s evaluation at 2 years of follow-up.Results:A total of 156 patients were evaluated. No significant differences were found between the groups in the preoperative evaluation. In the postoperative evaluation, patients in the ALL injury group had a higher reconstruction failure rate (14.3% vs 4.6% for the control group; P = .049) and worse clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.6; P < .00001). Although the pivot-shift test results were similar, anteroposterior translation using the KT-1000 arthrometer revealed worse results for the ALL injury group (2.8 ± 1.4 mm vs 1.9 ± 1.3 mm; P = .00018). Patients in the ALL injury group also had an increase in KT-1000 arthrometer values from 2 to 5 years (2.4 ± 1.6 vs 2.8 ± 1.4; P = .038). Patients in the control group had no differences in outcomes from 2 to 5 years of follow-up.Conclusion:Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after isolated ACL reconstruction with hamstring autograft. Patients with concomitant ALL injury showed a higher failure rate and worse functional scores. Also, knee stability tended to slightly worsen from 2 to 5 years in cases of associated ALL injury.

中文翻译：

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术前前外侧韧带损伤对用腿筋移植进行孤立急性 ACL 重建后结果的影响：一项至少 5 年随访的前瞻性研究


背景：术前磁共振成像（MRI）显示的前外侧韧带（ALL）病变对前交叉韧带（ACL）重建术中长期手术结果的潜在影响仍存在争议。对术前使用 MRI 诊断的患有或不患有 ALL 损伤的患者进行至少 5 年随访后的孤立 ACL 重建的结果和失败率。证据级别，2。方法：根据术前 MRI 存在 ALL 损伤（ALL 损伤组）或不存在 ALL 损伤（对照组），将急性 ACL 损伤患者的前瞻性队列分为 2 组。这是对之前发表的一项至少进行了 2 年随访的研究的长期随访研究。两组均接受了 ACL 的解剖学分离重建。评估了 Lysholm 和国际膝关节文献委员会主观评分、KT-1000 关节计和枢轴移位测试、重建失败率、对侧 ACL 损伤的发生率、相关半月板损伤的存在以及膝关节过度伸展的存在。 5年随访时的评估也与同一患者2年随访时的评估进行比较。结果：共有156名患者接受了评估。术前评估各组间未发现显着差异。在术后评估中，根据 Lysholm 评分，ALL 损伤组患者的重建失败率较高（14.3% vs 对照组 4.6%；P = .049），临床结果较差（85.0 ± 10.3 vs 92.3 ± 6.6） ; P < .00001)。 尽管枢轴移位测试结果相似，但使用 KT-1000 关节计进行前后平移显示 ALL 损伤组的结果更差（2.8 ± 1.4 毫米 vs 1.9 ± 1.3 毫米；P = .00018）。 ALL 损伤组患者的 KT-1000 关节计值在 2 至 5 年间也有所增加（2.4 ± 1.6 与 2.8 ± 1.4；P = .038）。对照组患者在 2 至 5 年的随访中，结果没有差异。结论：在分离后至少 5 年的随访中，ACL 和 ALL 联合损伤的预后明显低于单独的 ACL 损伤采用自体腿筋移植进行 ACL 重建。伴有 ALL 损伤的患者表现出较高的失败率和较差的功能评分。此外，在相关 ALL 损伤的情况下，膝盖稳定性在 2 至 5 年内往往会稍微恶化。