Objective: To explore the early effectiveness and influence on cartilage of local injection of multimodal drug cocktail (MDC) during anterior cruciate ligament reconstruction (ACLR).
Methods: Between February 2022 and August 2023, patients undergone arthroscopic ACLR using autologous hamstring tendons were selected as the study subjects. Among them, 90 patients met the selection criteria and were randomly divided into 3 groups ( n=30) according to the different injection drugs after ligament reconstruction. There was no significant difference in baseline data such as gender, age, body mass index, surgical side, disease duration, preoperative thigh circumference, and preoperative levels of tumor necrosis factor α (TNF-α), interleukin 6 (IL-6), IL-1, matrix metalloproteinase 3 (MMP-3), MMP-13, and aggrecan (ACAN) in synovial fluid between groups ( P>0.05). After the ligament reconstruction during operation, corresponding MDC (consisting of ropivacaine, tranexamic acid, and betamethasone in group A, and ropivacaine, betamethasone, and saline in group B) or saline (group C) were injected into the joint and tendon site, respectively. The length of hospital stay, postoperative tramadol injection volume, incidence of complications, degree of knee joint swelling and range of motion, visual analogue scale (VAS) score, International Knee Documentation Committee (IKDC) score, Lyshlom score, and Hospital for Special Surgery (HSS) score were recorded and compared between groups. The T2 * values in different cartilage regions were detected by MRI examination and the levels of TNF-α, IL-6, IL-1, MMP-3, MMP-13, and ACAN in synovial fluid were detected by ELISA method.
Results: The patients in group A, B, and C were followed up (12.53±3.24), (13.14±2.87), and (12.82±3.32) months, respectively. All incisions healed by first intention. Compared with group C, group A and group B had shorter length of hospital stay, less tramadol injection volume, and lower incidence of complications, showing significant differences ( P<0.05); there was no significant difference between group A and group B ( P>0.05). The degree of knee swelling in group A was significantly less than that in group B and group C ( P<0.05), but there was no significant difference between group B and group C ( P>0.05). At 3, 6, 12, 24, and 48 hours after operation, VAS scores of group A and group B were significantly lower than those of group C ( P<0.05); at 72 hours after operation, there was no significant difference among the three groups ( P>0.05). At 3 days, 14 days, and 1 month after operation, the range of motion of knee joint in group A were significantly better than those in group C ( P<0.05), and there was no significant difference between the other groups ( P>0.05). At 1 month after operation, the IKDC score of group A and group B was significantly higher than that of group C ( P<0.05); there was no significant difference among the three groups at other time points ( P>0.05). There was no significant difference in Lyshlom score and HSS score among the three groups at each time point ( P>0.05). At 14 days after operation, the levels of IL-1 and IL-6 in the synovial fluid in groups A and B were significantly lower than those in group C ( P<0.05). There was no significant difference in the levels of TNF-α, MMP-3, MMP-13, and ACAN between groups A and B ( P>0.05). At 1 month after operation, there was no significant difference in the above indicators among the three groups ( P>0.05). At 3, 6, and 12 months after operation, there was no significant difference in the T2 * values of different cartilage regions among the three groups ( P>0.05).
Conclusion: Injecting MDC (ropivacaine, tranexamic acid, betamethasone) into the joint and tendon site during ACLR can achieve good early effectiveness without significant impact on cartilage.
目的: 探讨前交叉韧带重建术（anterior cruciate ligament reconstruction，ACLR）中局部注射多模式混合药物（multimodal drug cocktail，MDC）的早期疗效及对软骨的影响。.
方法: 以2022年2月—2023年8月拟采用自体腘绳肌腱行关节镜下ACLR患者作为研究对象，其中90例符合选择标准纳入研究，根据韧带重建后注射药物不同随机分为3组（ n=30）。3组患者性别、年龄、身体质量指数、手术侧别、病程以及术前大腿周径及关节液中TNF-α、IL-6、IL-1、基质金属蛋白酶3（matrix metalloproteinase 3，MMP-3）、MMP-13、聚集蛋白聚糖（aggrecan，ACAN）含量等基线资料比较，差异均无统计学意义（ P>0.05）。术中韧带重建后，分别于关节内和取腱处注射对应MDC（A组由罗哌卡因、氨甲环酸、倍他米松组成，B组由罗哌卡因、倍他米松、生理盐水组成）或生理盐水（C组）。比较3组患者住院时间、术后曲马多注射量及并发症发生情况，膝关节肿胀程度及活动度、疼痛视觉模拟评分（VAS）、国际膝关节文献委员会（IKDC）评分、Lyshlom评分以及美国特种外科医院（HSS）评分；MRI检查不同软骨区域T2 *值；ELISA法检测关节液中TNF-α、IL-6、IL-1、MMP-3、MMP-13、ACAN含量。.
结果: 3组患者均获随访，A、B、C组随访时间分别为（12.53±3.24）、（13.14±2.87）、（12.82±3.32）个月。术后切口均Ⅰ期愈合。A、B组与C组相比，住院时间缩短、曲马多注射量减少、并发症发生率降低，差异均有统计学意义（ P<0.05）；A、B组间差异均无统计学意义（ P>0.05）。术后A组膝关节肿胀程度较B、C组减轻（ P<0.05），B、C组间差异无统计学意义（ P>0.05）。术后3、6、12、24、48 h时，A、B组VAS评分低于C组（ P<0.05）；术后72 h时3组间差异均无统计学意义（ P>0.05）。术后3 d、14 d、1个月，A组膝关节活动度优于C组（ P<0.05），其余组间比较差异无统计学意义（ P<0.05）。术后1个月时，A、B组IKDC评分高于C组（ P<0.05）；其余时间点组间比较差异均无统计学意义（ P>0.05）。各时间点Lyshlom评分及HSS评分组间比较差异均无统计学意义（ P>0.05）。ELISA检测术后14 d A、B组患膝关节液中IL-1和IL-6含量低于C组（ P<0.05），TNF-α、MMP-3、MMP-13、ACAN含量差异均无统计学意义（ P>0.05）；A、B组上述指标差异均无统计学意义（ P>0.05）。术后1个月时，上述各项指标组间比较差异均无统计学意义（ P>0.05）。术后3、6、12个月时，3组间各软骨区域T2 *值比较差异均无统计学意义（ P>0.05）。.
结论: ACLR术中关节内联合取腱处注射MDC（罗哌卡因、氨甲环酸、倍他米松）可获得良好早期疗效，且对软骨无明显影响。.
Keywords: Anterior cruciate ligament reconstruction; cartilage; early effectiveness; local injection; multimodal drug cocktail.