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Title: [Effect of different degrees of primary varus knee on short-term effectiveness of anterior cruciate ligament reconstruction].
Author: Ren F, Wu J, Zhao D, Wang R, Huang J.
Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2024 Jul 15; 38(7):823-829. PubMed ID: 39013819.
Abstract:
OBJECTIVE: To investigate whether different degrees of primary varus knee affect joint function and stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. METHODS: A clinical data of 160 patients with primary varus knee, who were admitted between January 2020 and December 2021 and met the selection criteria, was retrospectively analyzed. All patients underwent primary ACL reconstruction using autologous single-bundle hamstring tendon. Patients were divided into three groups based on the hip-knee-ankle angle (HKA): group A (64 patients with HKA 0°-3°), group B (55 patients with HKA 3°-6°), and group C (41 patients with HKA 6°-9°). Except for the significant difference in HKA among the three groups ( P<0.05), baseline data such as age, gender, affected side, body mass index, interval between injury and operation, Kellgren-Lawrence grading, posterior tibial slope, proportion of combined meniscal injuries, Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) objective score, anterior drawer test, Lachman test, pivot shift test, and the results of KT1000 (side-to-side difference, SSD) showed no significant difference ( P>0.05). At last follow-up, joint stability was assessed through the anterior drawer test, Lachman test, pivot shift test, and SSD; joint function was evaluated using the Tegner score, Lysholm score, and IKDC objective score. RESULTS: All incisions in the three groups healed by first intention after operation. All patients were followed up 24-31 months, with an average of 26 months; there was no significant difference in the follow-up time among the three groups ( Z=0.675, P=0.714). At last follow-up, the knee stability and functional assessment indicators in each group significantly improved when compared to preoperative ones ( P<0.05); there was no significant difference among the three groups ( P>0.05) in terms of the anterior drawer test, Lachman test, pivot shift test, IKDC objective scores, and the changes of the Lysholm scores and Tegner scores. The Kellgren-Lawrence grading and HKA at last follow-up were consistent with preoperative results in the three groups. CONCLUSION: Varying degrees of primary varus knee do not affect early knee joint stability and functional recovery after ACL reconstruction, and there is no significant difference in effectiveness between different degrees of varus knee. 目的: 探讨不同程度初级膝内翻对前交叉韧带（anterior cruciate ligament，ACL）重建术后早期膝关节功能和稳定性的影响。. 方法: 回顾性分析2020年1月—2021年12月收治且符合选择标准的160例合并初级膝内翻患者临床资料，均采用自体单束腘绳肌初次重建ACL。根据髋-膝-踝角（hip-knee-ankle angle，HKA）将患者分为3组，A组（0°～3°）64例、B组（3°～6°）55例、C组（6°～9°）41例。3组患者除HKA差异有统计学意义（ P<0.05）外，年龄、性别、侧别、身体质量指数、受伤至手术时间以及术前膝关节Kellgren-Lawrence分级、胫骨平台后倾角、合并半月板损伤构成比、Tegner评分、Lysholm评分、国际膝关节文献委员会（IKDC）客观评分、前抽屉试验、Lachman试验、轴移试验及健、患侧胫骨最大前移程度差值（side-to-side difference，SSD）等基线资料比较，差异均无统计学意义（ P>0.05）。末次随访时，通过前抽屉试验、Lachman试验、轴移试验和 SSD评估关节稳定性；使用Tegner评分、Lysholm评分和IKDC客观评分评估关节功能。. 结果: 3组术后切口均Ⅰ期愈合。患者均获随访，随访时间24～31个月，平均26个月；A、B、C组随访时间差异无统计学意义（ Z=0.675， P=0.714）。末次随访时，各组膝关节稳定性以及功能检测指标均较术前改善，差异有统计学意义（ P<0.05）；3组间前抽屉试验、Lachman试验、轴移试验、SSD变化值以及Lysholm评分变化值、Tegner评分变化值和IKDC客观评分比较，差异均无统计学意义（ P>0.05）。3组患者Kellgren-Lawrence分级、HKA与术前一致。. 结论: 初级膝内翻不会影响ACL重建术后早期膝关节稳定性和功能恢复，且不同程度膝内翻间疗效无明显差异。.

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