Comparative study of three-in-one procedure versus combined anterior cruciate ligament and anterolateral structure reconstruction for revision of anterior cruciate ligament reconstruction
10.3760/cma.j.cn121113-20250103-00010
- VernacularTitle:"三合一"重建与ACL联合前外侧结构重建治疗ACL重建失效的对比研究
- Author:
Simin LU
1
;
Zipeng YE
1
;
Jinzhong ZHAO
1
Author Information
1. 上海交通大学医学院附属上海市第六人民医院运动医学科，上海 200233
- Publication Type:Journal Article
- Keywords:
Anterior cruciate ligament reconstruction;
Transplantation, autologous;
Joint instability
- From:
Chinese Journal of Orthopaedics
2025;45(16):1040-1048
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the clinical efficacy of three-in-one procedure versus combined anterior cruciate ligament (ACL) and anterolateral structure (ALS) reconstruction in patients with ACL reconstruction failure.Methods:A total of 32 patients who underwent revision ACL reconstruction from January 2020 to March 2023 were included. The ipsilateral semitendinosus tendon, gracilis tendons, and the anterior half of the ipsilateral peroneus longus tendon, were harvested to constitute the autograft. In patients in whom the ipsilateral semitendinosus and gracilis tendons were unavailable, the bilateral anterior halves of the peroneus longus tendons were utilised. The ACL+ALS group, with bigger transplant graft (diameter >8 mm, n=17; males 13, females 4; mean age 28.29±7.90 years), ACL combined with ALS reconstruction were performed. The three-in-one group ( n=15; males 8, females 7; mean age 29.53±6.73 years) underwent additional iliotibial band (ITB) transposition for grafts with diameter <8 mm (excluding ITB). Operative time, intraoperative blood loss, and graft dimensions were compared. Graft healing was evaluated via postoperative MRI. Knee stability was evaluated via the Lachman test. Lysholm knee score, International Knee Documentation Committee (IKDC) score, knee injury and osteoarthritis outcome score (KOOS), and Tegner activity scale were compared preoperatively, 6-months postoperatively, and 12-months postoperatively, to assess knee function recovery. Results:Surgical parameters revealed that the ACL+ALS group had an operative time of 47.82±9.32 min, blood loss of 29.00±6.99 ml, graft diameter of 8.77±0.69 mm; three-in-one group had an operative time of 57.47±10.06 min, blood loss of 36.33±6.99 ml, graft diameter of 8.53±0.52 mm. Although graft diameter showed no significant intergroup difference ( t=1.065, P>0.05), the three-in-one group showed significantly longer operative times and greater blood loss ( t=2.815, P=0.009; t=2.746, P=0.010). The average follow-up time of the ACL+ALS group was 19.47±5.25 months (range, 12-28 months), whereas the three-in-one group was 20.40±6.50 months (range, 12-32 months). Postoperative MRI showed continuous and homogeneous graft signals in both groups at 6 and 12 months. Lachman test showed negative in 15 cases, grade I in 2 cases in the ACL+ALS group; and negative in 14 cases, grade I in 1 case in the three-in-one group. Both groups exhibited significant improvement from preoperative status ( P<0.001), with no intergroup difference ( P=1.000). Functional scores revealed that both groups showed significant improvement in Lysholm, IKDC, and Tegner scores at 6 and 12 months ( P<0.05 vs. preoperative), with no intergroup differences ( P>0.05). In KOOS subscales, the three-in-one group had significantly lower scores than the ACL+ALS group in pain (88.89±5.75 vs. 94.77±3.79 at 6 months; 89.26±5.93 vs. 96.41±3.22 at 12 months) and sports/recreation (71.33±12.32 vs. 83.53±9.31 at 6 months; 73.67±13.43 vs. 88.24±8.65 at 12 months; P<0.05). Conclusions:When the graft diameter is greater than or equal to 8 mm, both the three-in-one procedure and ACL combined with ALS reconstruction are effective for revision ACL reconstruction. However, patients who underwent three-in-one procedure experienced higher postoperative pain levels.
