Department of Orthopaedic Surgery, Incheon Medical Center, Incheon, South Korea.
Arthroscopy. 2010 Jan;26(1):41-9. doi: 10.1016/j.arthro.2009.06.026. Epub 2009 Dec 4.
The purpose of this study was to compare the outcomes after anterior cruciate ligament reconstructive surgery by use of bone-patellar tendon-bone (BPTB) allografts, tibialis anterior tendon (TA) allografts, and hamstring tendon (HA) autografts with respect to objective knee testing measures and second-look arthroscopy.
We analyzed 338 patients who had undergone anterior cruciate ligament reconstruction between March 2000 and February 2006. BPTB allografts were used in 60 cases, TA allografts in 153 cases, and HA autografts in 125 cases. We compared the grade of range of motion (ROM), Lachman test, pivot-shift test, KT-1000 arthrometric test (MEDmetric, San Diego, CA), and International Knee Documentation Committee (IKDC) knee examination form, as well as second-look arthroscopic findings, at least 1 year after reconstruction.
The preoperative ROM was not different among the 3 groups (P > .05), but the BPTB group and TA group showed greater postoperative ROM than the HA group (P = .028 and P < .001, respectively). There was no difference among the 3 groups in the other objective testing measurements (P > .05). Synovial coverage of more than 50% was found in 62.5% cases in the BPTB allograft group, 72.3% cases in the TA allograft group, and 90.7% cases in the HA autograft group. The incidence of synovial coverage of more than 50% was higher in the HA autograft group than that in the BPTB and TA allograft groups (P = .018 and P = .026, respectively). With regard to the IKDC grade, grade A or B was found in 95.2% of the cases with synovial coverage of more than 50% and in 78.3% of the cases with coverage of less than 50% (P = .011).
There was no difference in objective knee testing measures among the 3 different graft groups except that the allograft groups showed greater postoperative ROM than the autograft group. However, the HA autograft group had better synovial coverage on second-look arthroscopy, and the group with better synovial coverage on second-look arthroscopy presented better clinical results on the IKDC objective examination form.
本研究旨在通过比较使用骨-髌腱-骨（BPTB）同种异体移植物、胫骨前肌腱（TA）同种异体移植物和腘绳肌腱（HA）自体移植物进行前交叉韧带重建后的结果，评估客观的膝关节测试测量和二次关节镜检查。
我们分析了 2000 年 3 月至 2006 年 2 月期间接受前交叉韧带重建的 338 例患者。BPTB 同种异体移植物 60 例，TA 同种异体移植物 153 例，HA 自体移植物 125 例。我们比较了三组患者的关节活动度（ROM）、Lachman 试验、前抽屉试验、KT-1000 关节测量仪（MEDmetric，圣地亚哥，CA）和国际膝关节文献委员会（IKDC）膝关节检查表，以及至少 1 年后的二次关节镜检查结果。
三组患者术前 ROM 无差异（P >.05），但 BPTB 组和 TA 组术后 ROM 大于 HA 组（P =.028 和 P <.001）。三组患者其他客观测试测量无差异（P >.05）。BPTB 同种异体移植物组中有 62.5%的病例滑膜覆盖超过 50%，TA 同种异体移植物组中有 72.3%的病例滑膜覆盖超过 50%，HA 自体移植物组中有 90.7%的病例滑膜覆盖超过 50%。HA 自体移植物组滑膜覆盖超过 50%的发生率高于 BPTB 和 TA 同种异体移植物组（P =.018 和 P =.026）。在 IKDC 分级方面，滑膜覆盖超过 50%的病例中，A级或 B 级占 95.2%，滑膜覆盖小于 50%的病例中，A级或 B 级占 78.3%（P =.011）。
除了同种异体移植物组术后 ROM 大于自体移植物组外，三种不同移植物组之间的客观膝关节测试测量无差异。然而，HA 自体移植物组在二次关节镜检查中具有更好的滑膜覆盖，而在二次关节镜检查中具有更好滑膜覆盖的组在 IKDC 客观检查表中表现出更好的临床结果。
