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Evaluation of Anterolateral Ligament Healing After Anatomic Anterior Cruciate Ligament Reconstruction.
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2020-03-16 , DOI: 10.1177/0363546520908805
Dhong Won Lee 1 , Jin Goo Kim 2 , Hyun Tae Kim 1 , Seung Ik Cho 3
Affiliation  

Background:

Few studies have reported the healing process of anterolateral ligament (ALL) injuries.

Purpose/Hypothesis:

This study investigated the healing status of ALL injuries after primary anterior cruciate ligament (ACL) reconstruction (ACLR). Additionally, we investigated the association between the healing status of ALL injuries and associated lesions such as osseous lesions and meniscal tears occurring at the time of an ACL rupture. We hypothesized that acute ALL injuries show a high rate (more than two-thirds) of healing at the 1-year follow-up after ACLR and that concomitant lesions observed at the time of an ACL rupture affect the healing status of the ALL.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We retrospectively investigated patients with ALL injuries who underwent primary ACLR between March 2015 and February 2017. Using magnetic resonance imaging (MRI), we evaluated the features of ALL injuries and concomitant lesions, and MRI was performed at the 1-year follow-up to assess the healing status of the ALL. We investigated the association between the healing status of the ALL and concomitant lesions observed at the time of an ACL rupture. A subjective assessment was performed using the Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale. Objective tests included an isokinetic strength assessment and functional performance testing.

Results:

With respect to the severity of ALL injuries, of 54 patients, a complete rupture occurred in 16 (29.6%) of the 54 patients and a partial rupture in 38 (70%). A significant association was observed between the severity of ALL injuries and bone contusions (lateral tibial plateau and medial tibial plateau [MTP]) and meniscus ramp lesions (Fisher exact test: P = .023, .012, and .023, respectively). Good and partial healing of the ALL occurred in 16 (29.6%) and 23 (42.6%) of 54 patients, respectively. Scar formation occurred in 12 (22.2%), and nonvisualization of the ALL was observed in 3 (5.6%) of 54 patients. Poor healing of the ALL was associated with preoperative MTP bone contusions and a high-grade pivot shift. Multivariate analysis showed that an MTP bone contusion was an independent risk factor associated with poor healing of the ALL. Among the functional tests performed, significant differences were observed between the good and poor healing groups with respect to the carioca test (P = .039). The good healing group (n = 16) showed a negative pivot shift at the last follow-up, whereas 5 (13.2%) of the patients from the poor healing group (n = 38) showed a positive pivot shift, including 2 (5.3%) with a high-grade pivot shift.

Conclusion:

Approximately 70% of acute ALL injuries showed poor healing at the 1-year follow-up. Poor healing of ALL injuries was significantly associated with preoperative MTP bone contusions and a high-grade pivot shift. Therefore, a careful assessment of posteromedial bone contusions at the time of an ACL rupture is warranted, particularly in patients with a high-grade pivot shift.



中文翻译:

解剖前交叉韧带重建后前韧带愈合的评估。

背景:

很少有研究报道前外侧韧带(ALL)损伤的愈合过程。

目的/假设:

本研究调查了原发前十字韧带(ACL)重建(ACLR)后ALL损伤的愈合情况。此外,我们调查了ACL破裂时ALL损伤的愈合状态与相关病变(如骨性病变和半月板撕裂)之间的关系。我们假设急性ALL损伤在ACLR后的1年随访中显示出较高的治愈率(超过三分之二),并且在ACL破裂时观察到的伴随病变会影响ALL的愈合状态。

学习规划:

病例对照研究;证据水平3。

方法:

我们回顾性研究了2015年3月至2017年2月间接受了原发性ACLR的ALL损伤患者。我们使用磁共振成像(MRI)评估了ALL损伤和伴随病变的特征,并在1年随访中进行了MRI检查。评估ALL的治愈状态。我们调查了ALL的愈合状态与ACL破裂时观察到的伴随病变之间的关系。使用Lysholm评分,国际膝关节文献委员会主观评分和Tegner活动量表进行主观评估。客观测试包括等速肌力评估和功能性能测试。

结果:

关于ALL损伤的严重程度,在54例患者中,有54例患者中有16例(29.6%)发生了完全破裂,在38例(70%)中发生了部分破裂。在ALL损伤的严重程度和骨挫伤(胫骨外侧平台和内侧胫骨平台[MTP])与半月板斜面病变之间存在显着相关性(Fisher精确检验:P分别为.023,.012和.023)。ALL的良好和部分治愈分别发生在54例患者中的16例(29.6%)和23例(42.6%)。在12例(22.2%)中发生了瘢痕形成,在54例患者中有3例(5.6%)观察到了ALL的不可视性。ALL的愈合不良与术前MTP骨挫伤和高度枢转移位有关。多变量分析表明,MTP骨挫伤是与ALL愈合不良相关的独立危险因素。在进行的功能性测试中,好转和差转治愈组之间的颈肌测试存在显着差异(P= .039)。良好的康复组(n = 16)在最后一次随访中显示出负的枢轴偏移,而来自较差的康复组(n = 38)的患者中有5(13.2%)显示出正的枢轴偏移,包括2(5.3) %),并具有高级枢轴位移。

结论:

在1年的随访中,约70%的急性ALL损伤显示出较差的愈合。ALL损伤的愈合不良与术前MTP骨挫伤和高度枢转移位显着相关。因此,有必要对ACL破裂时后内侧骨挫伤进行仔细评估,尤其是对于高度枢纽移位的患者。

更新日期:2020-04-03
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