PURPOSE:The purpose of this study was to test whether low-grade Lachman test (i.e. Grade 0-1+) and a negative pivot shift at 6-12 weeks post-ACL rupture in recreational alpine skiers can be used to predict good function and normal knee laxity in nonoperated patients at minimum 2 years after the injury. METHODS:Office registry was used to identify 63 recreational alpine skiers treated by the senior author within 6 weeks of a first-time ACL injury between 2003 and 2008. Of these, 34 had early ACL reconstruction but 29 patients were observed and re-evaluated. Office charts and MRI were reviewed. Inclusion criteria for this study were as follows: ACL rupture documented on MRI after the injury, and minimum 2-year follow-up. Exclusion criterion was contralateral knee ligament injury. Of the 29 patients treated nonoperatively, 17 had low-grade Lachman and negative pivot shift tests within 6-12 weeks after the injury and were recommended to continue follow-up without surgery. Of these 17 patients, 6 were lost to follow up, but 11 patients were recalled and evaluated at more than 2 years after the injury. They completed Marx and Tegner activity level and IKDC subjective scores, physical examination of the knee and KT-1000 anterior laxity assessment. RESULTS:Median age at injury was 43 years (range 29-58). Median follow-up was 42 months (range 30-68). Mean IKDC subjective score at latest follow-up was 91.6 ± 6.7. Median Tegner score was 6 (range 6-9) before the injury and 6 (range 4-6) at latest follow-up (p = n.s). Median Marx score was 6 (range 0-16) before the injury and 4 (range 0-12) at latest follow-up (p = 0.03). Ten patients had Lachman Grade 0-1+, and one had Lachman Grade 2+ at latest follow-up. KT-1000 showed mean side-to-side difference of 0.8 ± 1.6 mm, and less than 3 mm difference in the 10 patients with Lachman Grade 0-1+. CONCLUSION:Recreational alpine skiers who sustain ACL injury should be re-evaluated at 6-12 weeks after the injury rather than being operated acutely. If they have negative Lachman and pivot shift tests at that point, they can be treated without surgery since good outcome and normal knee anterior laxity at more than 2 years after the injury is expected. LEVEL OF EVIDENCE:Case series, Level IV.

译文

目的:本研究的目的是测试休闲性高山滑雪者在ACL破裂后6-12周进行低度Lachman测试(即0-1级)和负枢轴位移是否可以用来预测良好的功能和正常状态受伤后至少2年内,非手术患者的膝盖松弛。
方法:使用Office注册表确定2003年至2008年首次ACL损伤6周内由资深作者治疗的63名休闲高山滑雪者。其中34例早期ACL重建,但观察并重新评估了29例患者。审查了办公室图表和MRI。这项研究的纳入标准如下:受伤后MRI记录ACL破裂,至少进行2年随访。排除标准为对侧膝关节韧带损伤。在非手术治疗的29例患者中,有17例在受伤后6-12周内进行了低度Lachman和枢轴移位测试阴性,建议继续随访而不进行手术。在这17例患者中,有6例失去随访,但有11例患者在受伤后2年以上被召回并进行了评估。他们完成了Marx和Tegner的活动水平和IKDC主观评分,膝盖的身体检查以及KT-1000前松弛度评估。
结果:受伤时的中位年龄为43岁(范围29-58)。中位随访时间为42个月(范围30-68)。最近一次随访的IKDC主观平均得分为91.6±6.7。伤前Tegner评分中位数为6(范围6-9),而最近一次随访(p = n.s)为6(范围6-6)。受伤前的马克思得分中位数为6(范围0-16),最近一次随访中得分为4(范围0-12)(p = 0.03)。在最近的随访中,有10例Lachman为0-1级,而1例为Lachman为2级。在10例Lachman 0-1级患者中,KT-1000的平均左右差异为0.8±1.6 mm,并且差异小于3 mm。
结论:遭受ACL损伤的休闲高山滑雪者应在受伤后6-12周重新评估,而不要进行急性手术。如果他们当时的Lachman和枢轴移位测试阴性,则可以在不超过手术的情况下进行治疗,因为预期在受伤后2年以上可获得良好的预后和正常的膝前松弛。
证据级别:案例系列,IV级。

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