Feller J A, Webster K E, Gavin B
La Trobe University Musculoskeletal Research Centre, La Trobe University, Bundoora, Victoria 3086, Australia.
Knee Surg Sports Traumatol Arthrosc. 2001 Sep;9(5):260-6. doi: 10.1007/s001670100216.
This study documented postoperative morbidity during the first 4 months following anterior cruciate ligament (ACL) reconstruction using either patellar tendon or hamstring tendon autograft. Sixty-five patients undergoing primary arthroscopically assisted single-incision ACL reconstruction were randomized to have a central third bone patellar tendon bone autograft (PT) or a doubled semitendinosus/doubled gracilis autograft (HS). Postoperatively patients undertook a standard 'accelerated' rehabilitation protocol. Patients were reviewed after 2 weeks, 8 weeks, and 4 months. At each review the location and severity of general knee pain and the presence and severity of anterior knee pain (AKP) were recorded as were the presence and size of an effusion as well as the active and passive flexion and passive extension deficits compared to the contralateral limb. Pain on kneeling, KT-1000 measured side to side difference in anterior tibial displacement, isokinetic assessment of quadriceps and hamstring peak torque deficits, IKDC score and Cincinnati sports activity level were also recorded after 4 months. After 2 weeks more patients in the PT group complained of AKP and reported that the pain was more severe. After 8 weeks there was no significant difference between the groups for any variable. After 4 months the severity of general pain experienced and the incidence of pain on kneeling were greater in the PT group. The PT group also demonstrated a significantly greater quadriceps peak torque deficit at 240 degrees /s. IKDC scores were higher in the HS group, but Cincinnati sports activity scores were higher in the PT group. Although we observed a lower morbidity in the HS group, primarily related to pain, the severity of pain in both groups was relatively low and, in light of the higher mean sports activity level observed in the PT group at 4 months the clinical impact of the difference may not be significant.
本研究记录了在前交叉韧带（ACL）重建术后的前4个月内，使用髌腱或腘绳肌腱自体移植的术后发病率。65例行初次关节镜辅助单切口ACL重建的患者被随机分为两组，分别接受中央三分之一带骨髌腱骨自体移植（PT）或双股半腱肌/双股股薄肌自体移植（HS）。术后患者采用标准的“加速”康复方案。分别在术后2周、8周和4个月对患者进行复查。每次复查时，记录膝关节总体疼痛的部位和严重程度、前膝疼痛（AKP）的存在及严重程度、积液的存在及大小，以及与对侧肢体相比的主动和被动屈曲及被动伸展功能障碍。4个月后还记录了跪姿疼痛、KT-1000测量的胫骨前移侧方差异、股四头肌和腘绳肌等速峰值扭矩功能障碍、IKDC评分以及辛辛那提运动活动水平。术后2周，PT组有更多患者主诉AKP，且报告疼痛更严重。8周后，两组在任何变量上均无显著差异。4个月后，PT组经历的总体疼痛严重程度和跪姿疼痛发生率更高。PT组在240度/秒时还表现出明显更大的股四头肌峰值扭矩功能障碍。HS组的IKDC评分更高，但PT组的辛辛那提运动活动评分更高。尽管我们观察到HS组的发病率较低，主要与疼痛有关，但两组的疼痛严重程度相对较低，鉴于4个月时PT组观察到的平均运动活动水平较高，这种差异的临床影响可能并不显著。
