Background:Primary repair of the anterior cruciate ligament (ACL) has some potential advantages over the reconstruction technique, which include but are not limited to better knee sensation due to preservation of the natural ACL tissue in patients compared with tendon graft. Proprioception is impaired after ACL injuries and the sense of the joint position is lost.Purpose/Hypothesis:The purpose of this study was to compare arthroscopic ACL primary repair and ACL reconstruction techniques clinically and functionally and analyze the differences in proprioception. It was hypothesized that primary repair would restore knee joint proprioception more successfully because the original tissue of the ACL is preserved.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 63 patients (34 underwent reconstruction and 29 underwent primary repair between 2017 and 2020) and 33 healthy controls, as well as the healthy knees of the operated groups, were evaluated between 24 and 48 months (mean, 29 months) postoperatively. Patients with proximal femoral avulsion tears and stump quality suitable for repair underwent primary repair, and those with tears outside these criteria underwent reconstruction using hamstring tendon autograft. Proprioception was evaluated using the active joint position sensation method during weightbearing, with a digital inclinometer used to measure differences between the target and achieved flexion angles of 15°, 30°, and 60°.Results:At 15° of knee flexion, the deviation angles for the healthy knee of the reconstruction and primary repair groups were significantly smaller than those of the control group ( P < .001), but there was no statistically significant difference between the groups in terms of deviation angle at 30° and 60° of flexion. The deviation angle of the operated knees was statistically significantly larger in the reconstruction group than in the primary repair group at all angles. The deviation angles at 15°, 30°, and 60° were 2.83°, 2.66°, and 2.66° in the reconstruction group and 1.00°, 1.00°, and 1.33° in the primary repair group, respectively ( P < .001). There was no statistically significant difference between the reconstruction and primary repair groups in terms of clinical scores.Conclusion:Primary ACL repair can preserve proprioception in a well-selected patient group. In short-term follow-up, primary repair of the ACL in patients with proximal femoral avulsion tears and stump quality suitable for repair appears to be proprioceptively protective. Future studies are needed to clarify the long-term consequences of primary repair on proprioception in a larger population.

中文翻译：

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前十字韧带初次修复后的本体感觉

背景：与重建技术相比，前交叉韧带（ACL）的初次修复具有一些潜在的优势，其中包括但不限于与肌腱移植相比，由于保留了患者的天然 ACL 组织，因此可以提供更好的膝关节感觉。ACL损伤后本体感觉受损，关节位置感丧失。目的/假设：本研究的目的是比较关节镜下ACL初次修复和ACL重建技术的临床和功能，并分析本体感觉的差异。假设初次修复会更成功地恢复膝关节本体感觉，因为 ACL 的原始组织被保留。证据级别，3。方法：在24至48个月期间对63名患者（2017年至2020年期间34名患者接受重建，29名接受初次修复）和33名健康对照者以及手术组的健康膝关节进行评估术后（平均 29 个月）。股骨近端撕脱撕裂且残端质量适合修复的患者接受初次修复，撕裂超出这些标准的患者则接受自体腘绳肌腱移植重建。采用负重时主动关节位置感觉法评估本体感觉，并使用数字倾斜仪测量目标与屈曲角度15°、30°和60°之间的差异。结果：膝关节屈曲15°时，偏差重建组和初次修复组的健康膝关节角度均显着小于对照组（ P < .001），但在 30° 和 60° 的偏斜角度方面，各组之间无统计学差异。屈曲。重建组手术膝的偏斜角度在各个角度均显着大于初次修复组。重建组15°、30°和60°的偏斜角分别为2.83°、2.66°和2.66°，初次修复组分别为1.00°、1.00°和1.33°（ P < .001） 。重建组和初次修复组的临床评分无统计学差异。结论：初次ACL修复可以在精心选择的患者组中保留本体感觉。在短期随访中，股骨近端撕脱撕裂且残端质量适合修复的患者的 ACL 初次修复似乎具有本体感觉保护作用。未来的研究需要阐明初级修复对更多人群本体感觉的长期影响。