目的:比较孤立ACL重建患者与在索引ACL重建(ACLR)时手术或非手术处理的同时发生MCL损伤的患者之间的修正率。
方法:在PearlDiver-Mariner数据库中查询了所有在2016-2020年期间接受ACLR的患者,使用特定于侧向的国际疾病分类,第十次修订(ICD-10)和当前程序术语(CPT)代码。如果患者年龄在15岁或更高,并且在指数ACLR后至少随访2年,则将其包括在内。然后根据是否存在伴随的MCL损伤将患者分为队列。合并MCL损伤的队列进一步细分为非手术治疗的MCL损伤,MCL修复,或在索引ACLR时进行MCL重建。在队列之间进行多变量回归以评估与修订ACLR相关的因素。
结果:我们确定了47,306例孤立的ACL损伤和10,846例伴随的MCL和ACL损伤。93%的合并MCL损伤患者的MCL非手术治疗;然而,从2016年至2020年,接受MCL损伤手术治疗的患者比例每年增加70%.与孤立的ACL损伤患者相比,合并MCL损伤患者进行ACLR翻修的几率更高(OR:1.50,95CI:1.36-1.66,p<0.001)。在伴随MCL损伤的患者中,与非手术管理的MCL损伤相比,手术管理的患者发生翻修ACLR的风险更高(OR:1.39,95CI:1.01~1.86,p=0.034).
结论:尽管手术管理的伴随MCL损伤有所增加,大多数伴随的MCL损伤在ACLR时仍非手术治疗.伴随MCL损伤的患者,特别是那些手术管理的,与孤立的ACL损伤患者相比,ACLR患者需要翻修ACLR的风险增加.
OBJECTIVE: To compare rates of revisions between patients with isolated anterior cruciate ligament (ACL) reconstruction and those who had concomitant medial collateral ligament (MCL) injuries managed either operatively or nonoperatively at the time of index anterior cruciate ligament reconstruction (ACLR).
METHODS: Using laterality-specific International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) codes, we queried the PearlDiver-Mariner Database for all patients who underwent ACLR between 2016 and 2020. Patients were included if they were ages 15 or older and had a minimum of 2 years of follow-up after index ACLR. Patients were then divided into cohorts by presence or absence of concomitant
MCL injury. The cohort of concomitant
MCL injuries was further subdivided into those with
MCL injuries managed nonoperatively, with
MCL repair, or with
MCL reconstruction at the time of index ACLR. Multivariate regression was performed between cohorts to evaluate for factors associated with revision ACLR.
RESULTS: We identified 47,306 patients with isolated ACL injuries and 10,846 with concomitant MCL and ACL injuries. In total, 93% of patients with concomitant
MCL injuries had their
MCL treated nonoperatively; however, the annual proportion of patients being surgically managed for their MCL injury increased by 70% from 2016 to 2020. Concomitant MCL injury patients had greater odds of undergoing revision ACLR compared with patients with isolated ACL injuries (odds ratio 1.50, 95% confidence interval 1.36-1.66, P < .001). Among patients with concomitant MCL injuries, surgically managed patients had a greater risk of revision ACLR compared with nonoperatively managed MCL injuries (odds ratio 1.39, 95% confidence interval 1.01-1.86, P = .034).
CONCLUSIONS: Despite an increase in operatively managed concomitant MCL injuries, most concomitant
MCL injuries were still managed nonoperatively at the time of ACLR. Patients with concomitant MCL injuries, particularly those managed operatively, at the time of ACLR are at increased risk of requiring revision ACLR compared with those with isolated ACL injuries.
METHODS: Level III, retrospective comparative case series.