Tibial-sided Anterolateral Ligament Injuries Are Associated With Poor Healing and Residual Pivot Shift Testing After Anterior Cruciate Ligament Reconstruction.

Autor:	Lee DM; Department of Orthopedic Surgery, Gwangmyeong Sungae Hospital, Gwangmyeong, South Korea., Park HS; Department of Orthopedic Surgery, Eulji Medical Center, Seoul, South Korea., Choi NH; Department of Orthopedic Surgery, Eulji Medical Center, Seoul, South Korea. Electronic address: cnh2406@yahoo.com., Victoroff BN; Department of Orthopedic Surgery, Case Western Reserve University, Cleveland, Ohio, U.S.A.
Jazyk:	angličtina
Zdroj:	Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association [Arthroscopy] 2024 Jun 06. Date of Electronic Publication: 2024 Jun 06.
DOI:	10.1016/j.arthro.2024.05.024
Abstrakt:	Purpose: To investigate whether tibial-sided anterolateral ligament (ALL) injuries are associated with poor healing and residual pivot shift. Methods: Patients who underwent anterior cruciate ligament reconstructions within postinjury 6 weeks from January 2008 to March 2021 were included. They had concomitant ALL injury confirmed by preoperative magnetic resonance imaging (MRI) and were followed for a minimum of 20 months. Preoperative ALL injury was graded by the Muramatsu classification, and postoperative ALL healing were graded by a modification of the Lee classification (good, partial, and nonvisualized). The patients were allocated to an improved group (IG) and an unimproved group (UG) on the basis of a comparison of pre- and postoperative MRI. ALL tear site, postoperative knee stability, Lysholm score, and Tegner activity scale (patient-reported outcomes [PROs]) were compared between the 2 groups. Results: In total, 128 patients were enrolled; 94.5% patients achieved the minimal clinically important difference for PROs, respectively. The ALL was torn at the femoral side in 46.9% patients, at midsubstance in 31.2.%, and at tibial side in 21.9%, Preoperatively, 86 (67.2%) patients had a partial tear, and 42 (32.8%) patients had a complete tear. On the basis of the postoperative MRI appearances, 38 (29.7%) and 90 (70.3%) patients were allocated to the IG and UG, respectively. The tibial-side tears were significantly frequent in the UG (P = .032). Pivot shift showed a significantly greater incidence in the UG than IG (P = .004). Lachman test and PROs did not differ between the 2 groups. Conclusions: Tibial-sided ALL tears occurred in 18.7% of the UG compared with 3.2% of the IG, and 45.6% of the UG had a postoperative grade 1 or 2 pivot shift compared with 15.8% of the IG. Percentages of patients with the minimal clinically important difference for PROs did not differ between the 2 groups. However, the clinical relevance is limited by a high transfer bias. Level of Evidence: Level III, retrospective cohort study. Competing Interests: Disclosures The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material. (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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