More knee reinjuries after ACL reconstruction compared to nonsurgical treatment of the ACL. A 2-year follow-up of the NACOX prospective cohort study

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-10-03 DOI:10.1002/ksa.12473

Anna S. Selin, Håkan Gauffin, Henrik Hedevik, Anne Fältström, Joanna Kvist

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Abstract

Purpose

To describe knee reinjuries and surgeries within 2 years after an acute anterior cruciate ligament (ACL) injury, in patients treated with or without ACL reconstruction (ACLR).

Methods

Two years follow-up of 275 patients (52% females, mean age 25.2 [SD 7.0] years) about knee reinjuries and surgeries were analysed from the prospective NACOX cohort study, aiming to describe recovery after an acute ACL injury treated according to clinical routine. Knee reinjury was defined as increase or new symptoms due to new trauma. At 2 years after injury, 169 (61%) had undergone an ACLR. Results are presented with descriptive statistics and risk ratios (RR).

Results

Thirty-two patients sustained reinjuries within 2 years; 6 in the non-ACLR group, and 26 in the ACLR group (7 before and 19 after ACLR). Twelve patients in the ACLR group sustained a graft rupture and three did an ACL revision. Patients with non-ACLR, aged 21–25 years, had a 5.9-fold higher risk for reinjury than those aged 15–20 years (RR 5.9 [1.3–26.9]; p = 0.012). Twenty-four patients had surgery in the non-ACLR group and 36 patients in the ACLR group (excluding primary ACLR), where six were before ACLR and 30 were after ACLR.

Conclusion

Twelve percent sustained a knee reinjury and 21% underwent knee surgery within 2 years after the index ACL injury. There was a higher reinjury incidence in the ACLR group, but no difference in incidence of surgeries. Thus, ACLR did not reduce the risk of traumatic reinjuries or surgeries, which is important for treatment decision considerations.

Level of Evidence

Level I.

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与前交叉韧带非手术治疗相比，前交叉韧带重建术后膝关节再损伤更多。NACOX前瞻性队列研究的两年随访。

目的：描述急性前交叉韧带（ACL）损伤后两年内，接受或未接受ACL重建（ACLR）治疗的患者的膝关节再损伤和手术情况：对前瞻性NACOX队列研究中275名患者（52%为女性，平均年龄25.2 [SD 7.0]岁）两年内膝关节再损伤和手术的随访情况进行了分析，旨在描述按照临床常规治疗急性前交叉韧带损伤后的恢复情况。膝关节再损伤的定义是由于新的创伤导致症状加重或出现新的症状。受伤 2 年后，169 人（61%）接受了前交叉韧带重建手术。结果显示了描述性统计和风险比（RR）：32名患者在2年内再次受伤，其中非 ACLR 组 6 人，ACLR 组 26 人（7 人在 ACLR 之前，19 人在 ACLR 之后）。前交叉韧带重建组中有12名患者发生移植物断裂，3名患者进行了前交叉韧带翻修。21-25 岁的非 ACLR 患者再次受伤的风险是 15-20 岁患者的 5.9 倍（RR 5.9 [1.3-26.9]; p = 0.012）。非 ACLR 组有 24 名患者接受了手术，ACLR 组（不包括初级 ACLR）有 36 名患者接受了手术，其中 6 人是在 ACLR 之前接受的手术，30 人是在 ACLR 之后接受的手术：结论：在前交叉韧带损伤后的两年内，12%的患者膝关节再次损伤，21%的患者接受了膝关节手术。前交叉韧带重建组的再损伤发生率较高，但手术发生率没有差异。因此，前交叉韧带置换术并没有降低创伤性再损伤或手术的风险，这对治疗决策的考虑非常重要：证据等级：一级。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).