Department of Orthopaedics, Södersjukhuset, Stockholm, Sweden.
Am J Sports Med. 2010 Aug;38(8):1533-41. doi: 10.1177/0363546510369549. Epub 2010 Jun 21.
Randomized controlled trials after anterior cruciate ligament reconstructions with long-term follow-up including assessment of health-related quality of life are rare.
To compare clinical outcome and health-related quality of life 8 years after anterior cruciate ligament reconstruction using 2 types of graft.
Randomized controlled trial; Level of evidence, 1.
Long-term follow-up of 164 patients with anterior cruciate ligament injury randomized to arthroscopic reconstruction with a quadrupled semitendinosus graft or a bone-patellar tendon-bone graft was undertaken. After a mean 8 years, 153 patients were available for follow-up, including instrumented laxity, 1-legged hop test, a knee-walking test, and assessment with International Knee Documentation Committee, Lysholm, Tegner, and patellofemoral pain score. Health-related quality of life was assessed with Knee Osteoarthritis Outcome Score and Short Form-36.
Patients in both graft groups retained the same stability, knee function, and health-related quality of life. The patellofemoral pain score was similar for both groups; the bone-patellar tendon-bone group had more donor site morbidity from kneeling and knee walking. In the bone-patellar tendon-bone group, 19 patients had no kneeling problems, 23 slight problems, 31 moderate problems, and 5 unable to kneel. Corresponding figures for the semitendinosus group were 25, 32, 16, and 2 (P < .001). Patients with early reconstructions (<5 months) had a lower risk for meniscal injuries (37%) than did later reconstructed (62%, P = .008). Health-related quality of life regarding physical functioning in Short Form-36 was better for the early-reconstructed patients than for the later reconstructed (92 vs 85; P = .014). Patients without medial meniscal surgery had higher Knee Osteoarthritis Outcome Scores for all subscales than did patients with medial meniscal surgery, with most significant difference for sport and recreation (63 vs 75, P = .008).
In the long term, the semitendinosus graft provided similar stability, knee function, and health-related quality of life but with less kneeling morbidity than did the bone-patellar tendon-bone graft.
前交叉韧带重建后进行长期随访，包括健康相关生活质量评估的随机对照试验很少见。
比较两种移植物在前交叉韧带重建 8 年后的临床结果和健康相关生活质量。
随机对照试验；证据水平，1 级。
对 164 例前交叉韧带损伤患者进行关节镜下重建，随机分为四股半腱肌腱重建组或骨-髌腱-骨重建组。平均 8 年后，153 例患者接受随访，包括仪器松弛度、单腿跳跃试验、膝关节行走试验和国际膝关节文献委员会、Lysholm、Tegner 和髌股疼痛评分评估。健康相关生活质量采用膝关节骨关节炎结局评分和简易 36 项健康调查量表评估。
两组患者均保留相同的稳定性、膝关节功能和健康相关生活质量。髌股疼痛评分两组相似；骨-髌腱-骨组因跪地和膝关节行走而导致更多供区疼痛。在骨-髌腱-骨组中，19 例患者无跪地问题，23 例轻微问题，31 例中度问题，5 例无法跪地。半腱肌腱组相应数据为 25、32、16 和 2（P <.001）。早期重建（<5 个月）患者半月板损伤风险较低（37%），晚期重建（62%，P =.008）。简易 36 项健康调查量表中，早期重建患者的身体功能相关健康相关生活质量优于晚期重建患者（92 分比 85 分；P =.014）。未行内侧半月板手术的患者在所有亚量表的膝关节骨关节炎结局评分均高于行内侧半月板手术的患者，差异最显著的是运动和娱乐亚量表（63 分比 75 分，P =.008）。
长期来看，半腱肌腱移植物提供了相似的稳定性、膝关节功能和健康相关生活质量，但跪地疼痛发生率低于骨-髌腱-骨移植物。
