Poehling Gary G, Curl Walton W, Lee Cassandra A, Ginn T Adam, Rushing Julia T, Naughton Michelle J, Holden Martha B, Martin David F, Smith Beth P
Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27151, USA.
Arthroscopy. 2005 Jul;21(7):774-85. doi: 10.1016/j.arthro.2005.04.112.
To prospectively compare outcomes of primary anterior cruciate ligament (ACL) reconstruction with either Achilles tendon allograft with soft-tissue fixation or standard bone-patellar tendon-bone autograft with interference screw fixation.
Prospective comparative case series.
A group of 41 patients who underwent soft-tissue allograft reconstruction and a group of 118 patients who underwent autograft bone-patellar tendon-bone reconstruction were included in the final results. Patients were evaluated preoperatively and postoperatively at 1 to 2 weeks, 6 weeks, 3 months, 6 months, and then annually for 5 years. Objective measures of outcome included KT-1000 measurements, range of motion, ligamentous integrity, thigh atrophy, and International Knee Documentation Committee score. Subjective evaluations included patient completion of 5 questionnaires documenting functional status, pain, and health-related quality of life: (1) the short-form McGill Pain Questionnaire, (2) a patient subjective assessment of knee function and symptoms, (3) a patient subjective assessment follow-up, (4) a knee pain scale, and (5) the RAND 36-Item Health Survey. Mixed models analysis of variance was used to compare the outcomes of the treatment groups using baseline values of the study variables as a covariate.
Autograft patients reported significantly more pain on the bodily pain subscale of the RAND-36 than the allograft group at 1 week (P = .0006), 6 weeks (P = .0007), and 3 months (P = .0270). Autograft patients reported more pain than allograft patients on the McGill Pain Scale visual analog scale at 1 to 2 weeks (P < .0001) and 6 weeks (P = .0147). Patient assessment of function and symptoms showed that a higher proportion of patients reported normal or nearly normal knee function in the allograft group than in the autograft group at 3 months (33% v 14%, P = .0558, respectively). Fewer activity limitations were reported by allograft patients than autograft patients at 6 weeks (P = .0501), 3 months (P = .0431), and 6 months (P = .0014). After reconstruction, the allograft group displayed significantly more laxity in KT-1000 measurements at all time points than the autograft group (P = .0520). These measurements decreased over time for both groups (P < .0001).
Five-year follow-up of patients undergoing ACL reconstruction with allograft versus autograft were compared objectively and subjectively. Both groups of patients achieved similar long-term outcomes. Overall, the allograft patients reported less pain at 1 and 6 weeks after surgery, better function at 1 week, 3 months, and 1 year, and fewer activity limitations throughout the follow-up period.
Level II, prospective cohort study.
前瞻性比较采用软组织固定的跟腱同种异体移植与采用干涉螺钉固定的标准骨-髌腱-骨自体移植进行初次前交叉韧带（ACL）重建的效果。
前瞻性比较病例系列。
最终结果纳入了一组41例行软组织同种异体移植重建的患者和一组118例行自体骨-髌腱-骨重建的患者。术前及术后1至2周、6周、3个月、6个月进行评估，之后每年评估一次，共5年。结果的客观测量指标包括KT-1000测量、活动范围、韧带完整性、大腿萎缩情况以及国际膝关节文献委员会评分。主观评估包括患者完成5份记录功能状态、疼痛及健康相关生活质量的问卷：（1）简短麦吉尔疼痛问卷，（2）患者对膝关节功能和症状的主观评估，（3）患者主观评估随访，（4）膝关节疼痛量表，（5）兰德36项健康调查。采用混合模型方差分析，以研究变量的基线值作为协变量来比较治疗组的结果。
在术后1周（P = 0.0006）、6周（P = 0.0007）和3个月（P = 0.0270）时，自体移植组患者在兰德36项健康调查的身体疼痛分量表上报告的疼痛明显多于同种异体移植组。在术后1至2周（P < 0.0001）和6周（P = 0.0147）时，自体移植组患者在麦吉尔疼痛量表视觉模拟量表上报告的疼痛多于同种异体移植组患者。患者对功能和症状的评估显示，在术后3个月时，同种异体移植组中报告膝关节功能正常或接近正常的患者比例高于自体移植组（分别为33%对14%，P = 0.0558）。在术后6周（P = 0.0501）、3个月（P = 0.0431）和6个月（P = 0.0014）时，同种异体移植组患者报告的活动受限情况少于自体移植组患者。重建后，在所有时间点，同种异体移植组在KT-1000测量中的松弛度均明显高于自体移植组（P = 0.0520）。两组的这些测量值均随时间下降（P < 0.0001）。
对接受ACL重建的同种异体移植与自体移植患者进行了5年的客观和主观随访比较。两组患者均取得了相似的长期效果。总体而言，同种异体移植组患者在术后1周和6周时疼痛较轻，在术后1周、3个月和1年时功能较好，且在整个随访期间活动受限较少。
II级，前瞻性队列研究。
