在解剖学双束前交叉韧带重建术后一年，大多数患者都达到了患者可接受的症状状态和国际膝关节文献委员会主观膝关节表格评分的最小临床重要差异。

IF 2.7 Q1 ORTHOPEDICS Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine Pub Date : 2024-10-11 DOI:10.1016/j.jisako.2024.100344

Takeo Tokura, Yuichi Hoshino, Kanto Nagai, Kyohei Nishida, Noriyuki Kanzaki, Takehiko Matsushita, Ryosuke Kuroda

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引用次数: 0

摘要

目的：关于双束前交叉韧带重建术（DB-ACLR）后使用患者可接受症状状态（PASS）和最小临床重要性差异（MCID）概念得出临床结果的数据很少。本研究旨在使用 PASS 和 MCID 评估接受 DB-ACLR 患者一年的临床疗效：回顾性评估了298名（平均年龄26.9岁；145名男性/153名女性）和214名（平均年龄23.9岁；114名男性/100名女性）使用腘绳肌自体移植物接受初级DB-ACLR的患者的PASS和MCID达标情况。对获得 PASS 或 MCID 的患者的人口统计学、术前和术后数据进行了统计分析：在 298 例患者中，254 例（85.2%）达到了国际膝关节文献委员会-主观膝关节表（IKDC-SKF）的 PASS，214 例患者中有 191 例（88.8%）达到了 MCID。评估PASS成就的二分法逻辑回归分析表明，年龄较小（几率比[OR]，0.96；95% 置信区间[CI]，0.93-0.99；P = 0.013）、性别为男（OR，2.2；95% CI，1.08-4.83；P = 0.030）和一年内股四头肌力量对称性较好（OR，1.05；95% CI，1.03-1.07；P < 0.001）是PASS成就的独立预测因素。就 MCID 而言，术前 IKDC-SKF 评分低于第 50 百分位数（OR，14.39；95% CI，2.90-71.25；P = 0.001）和更好的一年股四头肌力量对称性（OR，1.035；95% CI，1.007-1.064；P = 0.014）是实现 MCID 的独立预测因素：超过85%的患者在接受腘绳肌腱自体移植的DB-ACLR手术一年后，IKDC-SKF评分达到PASS和MCID。一年后股四头肌力量对称性更好，这也是达到 PASS 和 MCID 的原因之一。专门针对股四头肌力量恢复的康复训练可能对DB-ACLR术后取得良好的临床效果非常重要：证据级别：IV，回顾性队列

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A majority of the patient achieved both patient-acceptable symptom state and minimal clinically important difference of International Knee Documentation Committee Subjective Knee Form score at one year after anatomical double-bundle anterior cruciate ligament reconstruction

Objectives

There is a paucity of data about clinical outcomes after double-bundle anterior cruciate ligament reconstruction (DB-ACLR) using the concepts of patient-acceptable symptom state (PASS) and minimal clinically important difference (MCID). The aim of the present study was to evaluate the one-year clinical outcomes of patients who underwent DB-ACLR using PASS and MCID.

Methods

Achievement of PASS and MCID were retrospectively evaluated for 298 (mean age 26.9 years; 145 men/153 women) and 214 patients (mean age 23.9 years; 114 males/100 females), respectively, who underwent primary DB-ACLR using a hamstring autograft. For patients who achieved PASS or MCID, demographics, preoperative and postoperative data were statistically analyzed.

Results

Of 298 patients, 254 (85.2%) achieved International Knee Documentation Committee-Subjective Knee Form (IKDC-SKF) PASS and 191 out of 214 patients (88.8%) achieved MCID. The dichotomous logistic regression analyses to assess the achievement of PASS showed that younger age (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.93–0.99; P = 0.013), male sex (OR, 2.2; 95% CI, 1.08–4.83; P = 0.030) and better one-year quadriceps strength symmetry (OR, 1.05; 95% CI, 1.03–1.07; P < 0.001) were independent predictors of PASS achievement. For MCID, preoperative IKDC-SKF score below the 50th percentile (OR, 14.39; 95% CI, 2.90–71.25; P = 0.001) and better one-year quadriceps strength symmetry (OR, 1.035; 95% CI, 1.007–1.064; P = 0.014) were independent predictors for MCID achievement.

Conclusions

More than 85% of the patients achieved PASS and MCID for the IKDC-SKF score one year after undergoing DB-ACLR with hamstring tendon autograft. Better quadriceps strength symmetry at one year contributed to the achievement of both PASS and MCID. Rehabilitation dedicated to quadriceps strength recovery may be important for achieving good clinical outcomes after DB-ACLR.