Background:

The indications for the addition of anterolateral soft tissue augmentation to anterior cruciate ligament (ACL) reconstruction and its effectiveness remain uncertain.

Purpose:

To determine if modified iliotibial band tenodesis (MITBT) can improve clinical outcomes and reduce the recurrence of ACL ruptures when added to ACL reconstruction in patients with a residual pivot shift.

Study Design:

Randomized controlled trial; Level of evidence, 2.

Methods:

Patients with a primary ACL rupture satisfying the following inclusion criteria were enrolled: first ACL rupture, involved in pivoting sports, skeletally mature, no meniscal repair performed, and residual pivot shift relative to the contralateral uninjured knee immediately after ACL reconstruction. Patients were randomized to group A (no further surgery) or group B (MITBT added) and were followed up for 2 years. The patient-reported outcome (PRO) measures used were the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS) subscale of sport/recreation (Sport/Rec), KOOS subscale of quality of life (QoL), Lysholm knee score (LKS), Tegner activity scale (TAS), recurrent ACL ruptures, or need for further surgery in either knee. Analysis of variance was used to compare PROs; the Wilcoxon test was used for the TAS; and the chi-square test was used for recurrence of ACL ruptures, meniscal injuries, and contralateral ACL ruptures (P < .05).

Results:

A total of 55 patients were randomized: 27 to group A (female:male ratio = 15:12; mean age, 22.3 ± 3.7 years) and 28 to group B (female:male ratio = 17:11; mean age, 21.8 ± 4.1 years). At 2-year follow-up, group A had a similar IKDC score (90.9 ± 10.7 vs 94.2 ± 11.2; respectively; P = .21), lower KOOS Sport/Rec score (91.5 ± 6.4 vs 95.3 ± 4.4, respectively; P = .02), similar KOOS QoL score (92.0 ± 4.8 vs 95.1 ± 4.3, respectively; P = .14), lower LKS score (92.5 ± 4.8 vs 96.8 ± 8.0, respectively; P = .004), lower TAS score (median, 7 [range, 7-9] vs 8 [range, 8-10], respectively; P = .03), higher rate of recurrence (14.8% vs 0.0%, respectively; P < .001), similar rate of meniscal tears (14.8% vs 3.6%, respectively; P = .14), and similar rate of contralateral ACL ruptures (3.7% vs 3.6%, respectively; P = .99) relative to group B.

Conclusion:

The augmentation of ACL reconstruction with MITBT reduced the risk of recurrent ACL ruptures in knees with a residual pivot shift after ACL reconstruction and improved KOOS Sport/Rec, LKS, and TAS scores.

Registration:

ACTRN12618001043224 (Australian New Zealand Clinical Trials Registry)

中文翻译：

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改良的lio胫束肌腱固定术可纠正自体Ham绳肌腱移植重建前十字韧带后的​​术中残余枢轴移位：一项前瞻性随机对照试验。

背景：

对于前交叉韧带（ACL）重建增加前外侧软组织增强的指征及其有效性仍然不确定。

目的：

为了确定改良的胫束肌腱膜增生症（MITBT）是否可以改善临床结局并减少ACL重建的复发，并将其添加到具有残留枢纽移位的患者的ACL重建中。

学习规划：

随机对照试验; 证据水平2。

方法：

纳入了满足以下纳入标准的原发性ACL破裂患者：首次ACL破裂，参与枢轴运动，骨骼成熟，未进行半月板修复，以及在ACL重建后立即相对于对侧未受伤的膝盖残留了枢轴移位。患者被随机分为A组（无进一步手术）或B组（加MITBT），并随访2年。使用的患者报告的结局（PRO）指标是国际膝关节文献委员会（IKDC）得分，膝关节损伤和骨关节炎结果得分（KOOS）运动/娱乐（Sport / Rec）子量表，KOOS生活质量的子量表（QoL） ，Lysholm膝关节评分（LKS），Tegner活动量表（TAS），复发性ACL破裂或需要在任一膝盖中进行进一步手术。方差分析用于比较专业人士；TAS使用Wilcoxon检验；卡方检验用于ACL破裂，半月板损伤和对侧ACL破裂的复发（P <.05）。

结果：

共有55名患者被随机分组​​：A组27名（男女比例= 15:12；平均年龄22.3±3.7岁），B组28名（女：男性比例= 17:11；平均年龄21.8± 4.1年）。在2年的随访中，A组的IKDC评分相似（分别为90.9±10.7和94.2±11.2；P = 0.21），较低的KOOS Sport / Rec评分（分别为91.5±6.4和95.3±4.4；P = .02），类似的KOOS QoL评分（分别为92.0±4.8和95.1±4.3; P = .14），较低的LKS分数（分别为92.5±4.8和96.8±8.0; P = .004），较低的TAS分数（中位，分别为7 [范围7-9]和8 [范围8-10]；P = .03），复发率较高（分别为14.8％和0.0％；P<.001），与B组相似的半月板撕裂发生率（分别为14.8％和3.6％; P = .14）和对侧ACL破裂的相似发生率（分别为3.7％和3.6％; P = .99） 。

结论：

用MITBT增强ACL重建可降低膝盖复发性ACL破裂的风险，并在ACL重建后残留枢转，并改善KOOS Sport / Rec，LKS和TAS评分。

注册：

ACTRN12618001043224（澳洲纽西兰临床试验注册处）