No difference in osteoarthritis, but less graft failures after 5 years, comparing anatomic double-bundle to anatomic single-bundle ACL reconstruction

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-11-07 DOI:10.1002/ksa.12528

Cathrine Aga, Ingrid Trøan, Stig Heir, May Arna Risberg, Tariq Rana, Steinar Johansen, Morten Wang Fagerland, Lars Engebretsen

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Abstract

Purpose

The purpose of this study was to compare the incidence of knee osteoarthritis (OA) between the anatomic single-bundle (SB) and anatomic double-bundle (DB) anterior cruciate ligament (ACL) reconstruction technique after 5-year follow-up (FU). Secondary objectives were to compare patient-reported outcome measures (PROMs), clinical examination, activity level, functional tests and graft failures between the two groups.

Methods

The study was a secondary analysis after 5-year FU of a randomized controlled trial (RCT) (Clinical Trials NCT01033188). One hundred and twenty patients between 18 and 40 years were randomized to either anatomic SB or anatomic DB reconstruction. The Kellgren–Lawrence (KL) classification grade ≥2 and the Osteoarthritis Research Society International (OARSI) atlas criteria score ≥2 were used for defining OA. Additionally, PROMs were obtained and clinical examinations of the knees were performed. Finally, the number of patients experiencing graft failure in each group was recorded.

Results

Radiographic imaging was performed in 39 patients in the SB group and in 37 patients in the DB group. Four patients (10%) in the SB group and two (5%) in the DB group developed osteoarthritis according to the KL classification (p = 0.28). Five (13%) in the SB group and three (8%) in the DB group developed osteoarthritis according to the OARSI atlas criteria (p = 0.59; difference 5.0% [95% confidence interval, CI: −0.10 to 0.20]). There were no significant differences in the PROMs, clinical examinations, activity levels, or functional tests when comparing the two groups. Of initially 62 SB patients, 14 (23%) experienced graft failure compared to 4 (7%) of the 58 DB patients (p = 0.015; difference 0.016 [95% CI: 0.03–0.29]).

Conclusion

At 5-year FU, there were no significant differences in the incidence of OA, PROMS, or other clinical findings comparing the anatomic DB to anatomic SB ACL reconstructed patients. There were fewer graft failures among patients treated with anatomic DB ACL reconstruction.

Level of Evidence

Level II.

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解剖双束前交叉韧带重建术与解剖单束前交叉韧带重建术相比，骨关节炎没有差异，但5年后移植物失败的情况较少。

目的：本研究旨在比较解剖型单束（SB）和解剖型双束（DB）前交叉韧带（ACL）重建技术5年随访（FU）后膝关节骨性关节炎（OA）的发生率。次要目标是比较两组患者报告的结果指标（PROMs）、临床检查、活动水平、功能测试和移植失败情况：该研究是一项随机对照试验（RCT）（临床试验 NCT01033188）5 年 FU 后的二次分析。120名年龄在18至40岁之间的患者被随机分配到解剖SB或解剖DB重建组。OA的定义采用凯尔格伦-劳伦斯（Kellgren-Lawrence，KL）分类等级≥2级和国际骨关节炎研究学会（Osteoarthritis Research Society International，OARSI）图谱标准评分≥2分。此外，还获得了 PROMs，并对膝关节进行了临床检查。最后，记录每组中移植失败的患者人数：SB组和DB组分别有39名和37名患者接受了放射影像学检查。根据 KL 分级，SB 组有 4 名患者（10%）和 DB 组有 2 名患者（5%）出现骨关节炎（P = 0.28）。根据 OARSI 图集标准，SB 组有 5 名患者（13%）和 DB 组有 3 名患者（8%）发展为骨关节炎（p = 0.59；差异为 5.0% [95% 置信区间，CI：-0.10 至 0.20]）。两组患者在 PROMs、临床检查、活动水平或功能测试方面没有明显差异。在最初的 62 名 SB 患者中，有 14 人（23%）出现移植失败，而在 58 名 DB 患者中，有 4 人（7%）出现移植失败（P = 0.015；差异为 0.016 [95% CI：0.03-0.29]）：在5年的FU中，解剖型DB与解剖型SB前交叉韧带重建患者在OA发生率、PROMS或其他临床结果方面没有明显差异。采用解剖DB前交叉韧带重建术的患者中，移植物失败的人数较少：证据等级：II。

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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).