PDF(Pubmed)
Abstract：
UNASSIGNED: Research on return to sport and psychological recovery in anterior cruciate ligament (ACL) revision remains scarce. The clinical efficacy of artificial ligament in ACL revision requires further exploration. Our objectives were (1) to compare the midterm clinical outcomes of artificial ligament versus allogenic tendon graft in ACL revision and (2) to analyze the effects of employing artificial ligament on return to sport and psychological recovery in ACL revision.
UNASSIGNED: This cohort study included the cases receiving ACL revision from 2014 to 2021 in Sports Medicine Department of Huashan Hospital. The grafts used were Ligament Advanced Reinforcement System (LARS) and ATT allograft. We recorded patients\' baseline data. The final follow-up assessment included subjective scales, physical examination, and return to sport status. We recorded the rates and timings of return to sport. Subjective scales included the 2000 International Knee Documentation Committee (IKDC) subjective score, Lysholm Knee Scaling Score (LKSS), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity score, Marx activity rating score, and Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI). Anterior knee stability was assessed using the KT-1000 arthrometer.
UNASSIGNED: Fifty cases (LARS group: 27; ATT group: 23) enrolled and 45 (LARS group: 23; ATT group: 22) completed evaluations with a median follow-up period of 49 months. At recent follow-up, LARS group outperformed in knee stability (1.0 ± 1.9 mm vs. 2.6 ± 3.0 mm, P = 0.039), confidence (86.7 ± 12.4 vs. 69.4 ± 18.6, P < 0.001), emotion (82.7 ± 11.3 vs. 70.7 ± 16.2, P < 0.001), KOOS knee function (78.7 ± 8.8 vs. 69.5 ± 11.0, P = 0.003), quality of life (79.1 ± 16.1 vs. 66.4 ± 19.5, P = 0.014), Tegner score (6.3 ± 1.9 vs. 5.2 ± 2.1, P < 0.001), and Marx activity score (10.7 ± 3.7 vs. 7.9 ± 4.0, P = 0.012). The LARS group had significantly higher return rates: recreational (91.3 % vs. 63.6 %, P = 0.026), knee cutting and pivoting (87.0 % vs. 59.1 %, P = 0.035), competitive (78.3 % vs. 45.5 %, P = 0.023), and pre-injury (56.5 % vs. 27.3 %, P = 0.047). For return timings, the LARS group was earlier at recreational (11.2 ± 3.9 vs. 27.8 ± 9.0 weeks, P < 0.001), knee cutting and pivoting (17.2 ± 5.8 vs. 35.6 ± 13.8 weeks, P < 0.001), competitive (24.8 ± 16.2 vs. 53.2 ± 22.0 weeks, P < 0.001), and pre-injury levels (32.8 ± 11.0 vs. 72.8 ± 16.9 weeks, P < 0.001).
UNASSIGNED: In ACL revision, using LARS demonstrated improved joint stability and functionality compared to using allogenic ATT four years postoperative. Patients accepting the LARS procedure exhibited higher rates and earlier timings of return to various levels of sport, indicating enhanced confidence and emotional resilience.
UNASSIGNED: In ACL revision, the choice of artificial ligament to shorten recovery time, thereby enabling patients to return to sport more quickly and effectively, is thought-provoking. The research value extends beyond mere graft selection, guiding future clinical trials and studies. This research enhances our understanding of the application value of artificial ligament in ACL revision, emphasizing the importance of psychological recovery and updating our perceptions of return to sport levels post-revision. It stimulates exploration into personalized rehabilitation programs and treatment strategies, aiming to optimize clinical outcomes and meet the real-world needs of patients with failed ACL reconstruction.
UNASSIGNED: This cohort study included the cases receiving ACL revision from 2014 to 2021 in Sports Medicine Department of Huashan Hospital. The grafts used were Ligament Advanced Reinforcement System (LARS) and ATT allograft. We recorded patients\' baseline data. The final follow-up assessment included subjective scales, physical examination, and return to sport status. We recorded the rates and timings of return to sport. Subjective scales included the 2000 International Knee Documentation Committee (IKDC) subjective score, Lysholm Knee Scaling Score (LKSS), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity score, Marx activity rating score, and Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI). Anterior knee stability was assessed using the KT-1000 arthrometer.
UNASSIGNED: Fifty cases (LARS group: 27; ATT group: 23) enrolled and 45 (LARS group: 23; ATT group: 22) completed evaluations with a median follow-up period of 49 months. At recent follow-up, LARS group outperformed in knee stability (1.0 ± 1.9 mm vs. 2.6 ± 3.0 mm, P = 0.039), confidence (86.7 ± 12.4 vs. 69.4 ± 18.6, P < 0.001), emotion (82.7 ± 11.3 vs. 70.7 ± 16.2, P < 0.001), KOOS knee function (78.7 ± 8.8 vs. 69.5 ± 11.0, P = 0.003), quality of life (79.1 ± 16.1 vs. 66.4 ± 19.5, P = 0.014), Tegner score (6.3 ± 1.9 vs. 5.2 ± 2.1, P < 0.001), and Marx activity score (10.7 ± 3.7 vs. 7.9 ± 4.0, P = 0.012). The LARS group had significantly higher return rates: recreational (91.3 % vs. 63.6 %, P = 0.026), knee cutting and pivoting (87.0 % vs. 59.1 %, P = 0.035), competitive (78.3 % vs. 45.5 %, P = 0.023), and pre-injury (56.5 % vs. 27.3 %, P = 0.047). For return timings, the LARS group was earlier at recreational (11.2 ± 3.9 vs. 27.8 ± 9.0 weeks, P < 0.001), knee cutting and pivoting (17.2 ± 5.8 vs. 35.6 ± 13.8 weeks, P < 0.001), competitive (24.8 ± 16.2 vs. 53.2 ± 22.0 weeks, P < 0.001), and pre-injury levels (32.8 ± 11.0 vs. 72.8 ± 16.9 weeks, P < 0.001).
UNASSIGNED: In ACL revision, using LARS demonstrated improved joint stability and functionality compared to using allogenic ATT four years postoperative. Patients accepting the LARS procedure exhibited higher rates and earlier timings of return to various levels of sport, indicating enhanced confidence and emotional resilience.
UNASSIGNED: In ACL revision, the choice of artificial ligament to shorten recovery time, thereby enabling patients to return to sport more quickly and effectively, is thought-provoking. The research value extends beyond mere graft selection, guiding future clinical trials and studies. This research enhances our understanding of the application value of artificial ligament in ACL revision, emphasizing the importance of psychological recovery and updating our perceptions of return to sport levels post-revision. It stimulates exploration into personalized rehabilitation programs and treatment strategies, aiming to optimize clinical outcomes and meet the real-world needs of patients with failed ACL reconstruction.
摘要：
■关于前交叉韧带（ACL）翻修术中恢复运动和心理恢复的研究仍然很少。人工韧带在ACL翻修术中的临床疗效有待进一步探索。我们的目标是（1）比较ACL翻修术中人工韧带与同种异体肌腱移植的中期临床疗效；（2）分析在ACL翻修术中使用人工韧带对恢复运动和心理恢复的影响。
■本队列研究纳入华山医院运动医学科2014年至2021年接受ACL修订的病例。使用的移植物是韧带高级增强系统（LARS）和ATT同种异体移植物。我们记录了患者的基线数据。最终的随访评估包括主观量表，体检,回到运动状态。我们记录了重返体育运动的速度和时间。主观量表包括2000年国际膝关节文献委员会(IKDC)的主观评分，Lysholm膝关节缩放评分（LKSS），膝关节损伤和骨关节炎结果评分（KOOS），Tegner活动得分,马克思活动评分,和前交叉韧带-受伤后恢复运动（ACL-RSI）。使用KT-1000关节仪评估膝关节前稳定性。
■50例（LARS组：27；ATT组：23）和45例（LARS组：23；ATT组：22）完成评估，中位随访期为49个月。在最近的后续行动中，LARS组在膝关节稳定性方面优于（1.0±1.9mmvs.2.6±3.0mm,P=0.039),置信度（86.7±12.4vs.69.4±18.6,P<0.001),情绪（82.7±11.3vs.70.7±16.2，P<0.001），KOOS膝关节功能（78.7±8.8vs.69.5±11.0,P=0.003),生活质量（79.1±16.1vs.66.4±19.5,P=0.014),Tegner评分（6.3±1.9vs.5.2±2.1，P<0.001），和马克思活动得分(10.7±3.7vs.7.9±4.0,P=0.012)。LARS组的回报率明显更高：娱乐性(91.3%vs.63.6%,P=0.026),膝盖切割和旋转(87.0%vs.59.1%,P=0.035),竞争性（78.3%与45.5%,P=0.023),和受伤前(56.5%vs.27.3%,P=0.047)。对于返回时间，LARS组的娱乐性较早（11.2±3.9vs.27.8±9.0周，P<0.001)，膝盖切割和旋转(17.2±5.8vs.35.6±13.8周，P<0.001)，竞争性（24.8±16.2vs.53.2±22.0周，P<0.001)，和伤前水平(32.8±11.0vs.72.8±16.9周，P<0.001)。
■在ACL修订版中，与术后4年使用同种异体ATT相比,使用LARS的关节稳定性和功能得到改善.接受LARS手术的患者表现出更高的比率和更早的恢复到各种运动水平的时间。表明增强的信心和情绪韧性。
■在ACL修订版中，选择人工韧带缩短恢复时间,从而使患者能够更快，更有效地恢复运动，发人深省.研究价值不仅限于移植物选择，指导未来的临床试验和研究。这项研究提高了我们对人工韧带在ACL翻修术中的应用价值的认识,强调心理恢复的重要性，并更新我们对修订后恢复运动水平的看法。它激发了对个性化康复计划和治疗策略的探索，旨在优化临床结果并满足ACL重建失败患者的实际需求。
■本队列研究纳入华山医院运动医学科2014年至2021年接受ACL修订的病例。使用的移植物是韧带高级增强系统（LARS）和ATT同种异体移植物。我们记录了患者的基线数据。最终的随访评估包括主观量表，体检,回到运动状态。我们记录了重返体育运动的速度和时间。主观量表包括2000年国际膝关节文献委员会(IKDC)的主观评分，Lysholm膝关节缩放评分（LKSS），膝关节损伤和骨关节炎结果评分（KOOS），Tegner活动得分,马克思活动评分,和前交叉韧带-受伤后恢复运动（ACL-RSI）。使用KT-1000关节仪评估膝关节前稳定性。
■50例（LARS组：27；ATT组：23）和45例（LARS组：23；ATT组：22）完成评估，中位随访期为49个月。在最近的后续行动中，LARS组在膝关节稳定性方面优于（1.0±1.9mmvs.2.6±3.0mm,P=0.039),置信度（86.7±12.4vs.69.4±18.6,P<0.001),情绪（82.7±11.3vs.70.7±16.2，P<0.001），KOOS膝关节功能（78.7±8.8vs.69.5±11.0,P=0.003),生活质量（79.1±16.1vs.66.4±19.5,P=0.014),Tegner评分（6.3±1.9vs.5.2±2.1，P<0.001），和马克思活动得分(10.7±3.7vs.7.9±4.0,P=0.012)。LARS组的回报率明显更高：娱乐性(91.3%vs.63.6%,P=0.026),膝盖切割和旋转(87.0%vs.59.1%,P=0.035),竞争性（78.3%与45.5%,P=0.023),和受伤前(56.5%vs.27.3%,P=0.047)。对于返回时间，LARS组的娱乐性较早（11.2±3.9vs.27.8±9.0周，P<0.001)，膝盖切割和旋转(17.2±5.8vs.35.6±13.8周，P<0.001)，竞争性（24.8±16.2vs.53.2±22.0周，P<0.001)，和伤前水平(32.8±11.0vs.72.8±16.9周，P<0.001)。
■在ACL修订版中，与术后4年使用同种异体ATT相比,使用LARS的关节稳定性和功能得到改善.接受LARS手术的患者表现出更高的比率和更早的恢复到各种运动水平的时间。表明增强的信心和情绪韧性。
■在ACL修订版中，选择人工韧带缩短恢复时间,从而使患者能够更快，更有效地恢复运动，发人深省.研究价值不仅限于移植物选择，指导未来的临床试验和研究。这项研究提高了我们对人工韧带在ACL翻修术中的应用价值的认识,强调心理恢复的重要性，并更新我们对修订后恢复运动水平的看法。它激发了对个性化康复计划和治疗策略的探索，旨在优化临床结果并满足ACL重建失败患者的实际需求。
