Division of Rehabilitation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Am J Sports Med. 2010 Mar;38(3):448-54. doi: 10.1177/0363546509350301. Epub 2010 Jan 23.
The choice of different graft types and surgical techniques used when reconstructing a torn anterior cruciate ligament may influence the long-term prevalence of osteoarthritis and functional outcomes.
There are no differences in the prevalence of knee osteoarthritis or knee function in patients undergoing reconstruction of a torn anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft.
Randomized controlled trial; Level of evidence, 1.
Seventy-two patients with subacute or chronic rupture of the anterior cruciate ligament were randomly assigned to autograft reconstruction with 4-strand gracilis and semitendinosus tendon (HAM) (N = 37) or with patellar tendon-bone (PTB) (N = 35) from the ipsilateral side. Outcome measurements were the Cincinnati knee score, single-legged hop tests, isokinetic muscle strength tests, pain, knee joint laxity test (KT-1000 arthrometer), and a radiologic evaluation (Kellgren and Lawrence) at 10-year follow-up.
At 10 years, 57 patients (79%) were eligible for evaluation-29 in the HAM group and 28 in the PTB group. No differences were found between the 2 graft groups with respect to the Cincinnati knee score, the single-legged hop tests, pain, muscle strength measurements, or knee joint laxity. Fifty-five percent and 64% of the patients had osteoarthritis corresponding to Kellgren and Lawrence grade 2 or more in the HAM and the PTB groups, respectively (P =.27). For the uninvolved knee, the corresponding numbers were 28% and 22% (P = .62).
At 10 years postoperatively, no statistically significant differences in clinical outcome between the 2 graft types were found. The prevalence of osteoarthritis was significantly higher in the operated leg than in the contralateral leg, but there were no significant differences between the 2 groups. The results indicate that the choice of graft type after an anterior cruciate ligament injury has minimal influence on the prevalence of osteoarthritis 10 years after surgery.
在前交叉韧带撕裂的重建中，不同移植物类型和手术技术的选择可能会影响到长期的骨关节炎患病率和功能结果。
在前交叉韧带撕裂患者的重建中，使用 4 股腘绳肌腱自体移植物与髌腱-骨自体移植物相比，不存在膝骨关节炎或膝关节功能的患病率差异。
随机对照试验；证据水平，1 级。
72 例亚急性或慢性前交叉韧带断裂患者随机分为 4 股腘绳肌腱（HAM）自体移植物重建组（N = 37）或同侧髌腱-骨（PTB）自体移植物重建组（N = 35）。主要终点为 10 年随访时的辛辛那提膝关节评分、单腿跳跃试验、等速肌力测试、疼痛、膝关节松弛试验（KT-1000 关节测量仪）和影像学评估（Kellgren 和 Lawrence）。
10 年后，57 例患者（79%）可进行评估-37 例 HAM 组，28 例 PTB 组。2 个移植物组在辛辛那提膝关节评分、单腿跳跃试验、疼痛、肌肉力量测量或膝关节松弛度方面均无差异。在 HAM 组和 PTB 组中，分别有 55%和 64%的患者出现与 Kellgren 和 Lawrence 分级 2 级或更高级别的骨关节炎（P =.27）。对于未受累的膝关节，相应的数字分别为 28%和 22%（P =.62）。
术后 10 年，2 种移植物类型之间的临床结果无统计学差异。患侧膝关节的骨关节炎患病率明显高于对侧，但两组之间无显著差异。结果表明，前交叉韧带损伤后选择移植物类型对术后 10 年骨关节炎的患病率影响较小。
