У пациентов моложе 40 лет частота повторных операций после репарации ПКС через 5 лет выше, чем после реконструкции

Новые данные показывают, что хотя функциональные результаты после репарации передней крестообразной связки сопоставимы с реконструкцией, риск отказа трансплантата у молодых пациентов через пять лет достигает 15,5%. Эксперты рекомендуют сохранять реконструкцию стандартом лечения для молодых спортсменов, подверженных вращательным нагрузкам.

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Failure rate higher in younger patients 5 years after ACL repair vs. reconstruction Patients who underwent ACL repair had similar functional outcomes but higher failure rates at 5 years compared with patients who underwent ACL reconstruction, according to recently published data. “[The graft failure rate] at 2 years is acceptable, but at 5 years, it is absolutely a shame to have this result for a younger population,” Bertrand Sonnery-Cottet, MD, PhD, an orthopedic surgical consultant at the Centre Orthopédique Santy in Lyon, France, told Healio | Orthopedics Today. Researchers analyzed the same patients from a 2022 study by Sonnery-Cottet and colleagues that evaluated the clinical and functional outcomes of ACL repair vs. reconstruction 2 years after surgery. In the matched-pair analysis, the researchers assessed postoperative complications, rate of reoperation and patient-reported outcome measures (PROMs) of patients who underwent primary ACL repair or reconstruction between 2017 and 2019. Sonnery-Cottet and colleagues utilized a 1:1 ratio for variables like patient age, sex, BMI and preoperative pivot shift for the 71 matched pairs. Two senior surgeons used standardized surgical techniques for every procedure, and all patients received the same rehabilitation. The researchers collected PROMs via telemedicine visits during a midterm follow-up, including Tegner activity scale and Forgotten Joint Score-12 (FJS-12). Results indicated higher failure rates in the ACL repair group at 15.5% compared with 4.2% for patients in the reconstruction group. In a subgroup analysis, Sonnery-Cottet and colleagues found 10 of the 11 ACL repair failures were in patients aged younger than 40 years. Researchers noted no major difference in failure rate between the two groups in patients aged older than 40 years. Patients in the repair group who had preoperative pivot shift also had an increased risk for failure, with 28.6% of patients experiencing a graft rupture within 5 years vs. 3.7% of patients who had ACL reconstruction. “Our recommendation is very clear: ACL reconstruction should remain the standard treatment for high-risk populations, particularly young patients involved in pivoting sports,” Sonnery-Cottet told Healio | Orthopedics Today. “In patients over 40 years of age, ACL repair may be discussed on an individual basis, depending on patient characteristics and tear pattern.” - For more information: - Bertrand Sonnery-Cottet, MD, PhD, wishes to be contacted at [email protected].