Department of Orthopaedics, The Affiliated Hospital of Qingdao University Medical College, Qingdao, China.
Arthroscopy. 2011 Sep;27(9):1195-202. doi: 10.1016/j.arthro.2011.03.083. Epub 2011 Jul 22.
To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft versus irradiated allograft.
All irradiated hamstring tendon allografts (gracilis and semitendinosus), which were sterilized with 2.5 Mrad of irradiation before distribution, were obtained from a single certified tissue bank. A total of 78 patients undergoing arthroscopic ACL reconstruction were prospectively randomized consecutively into 1 of 2 groups: autograft and irradiated allograft. The same surgical technique was used in all operations, which were performed by the same senior surgeon. Before surgery and at a mean of 42.2 months of follow-up, patients were evaluated by the same observer according to objective and subjective clinical evaluations.
Of the patients, 67 (36 in autograft group and 31 in irradiated allograft group) were available for full evaluation. When the irradiated allograft group was compared with the autograft group at the final follow-up by the Lachman test, anterior drawer test, pivot-shift test, and KT-2000 arthrometer (MEDmetric, San Diego, CA) assessment, statistically significant differences were found (P = .00011, P = .00016, P = .008, and P = .00021, respectively). Most importantly, 86.1% of patients in the autograft group and only 32.3% in the irradiated allograft group had a side-to-side difference of less than 3 mm according to KT-2000 assessment. The rate of laxity (side-to-side difference >5 mm) with irradiated allograft (32.3%) was higher than that with autograft (8.3%). The anterior and rotational stabilities decreased significantly in the irradiated allograft group. According to the overall International Knee Documentation Committee rating, functional and subjective evaluations, and activity level testing, no statistically significant differences were found between the 2 groups. However, patients in the irradiated allograft group had a shorter operative time and a longer duration of postoperative fever. When the patients had a fever, the laboratory examination findings of all patients were almost normal (white blood cell count, normal; erythrocyte sedimentation rate, 8 to 20 mm/h; and C-reactive protein level, 4 to 11 mg/L).
The clinical outcome of ACL reconstruction with hamstring tendon autograft was satisfactory, whereas the difference in instrumented laxity between the 2 groups was significant and the difference in functional test results was not significant.
Level II, prospective comparative study.
比较关节镜下前交叉韧带（ACL）重建采用自体腘绳肌腱与照射同种异体移植物的临床结果。
所有照射的同种异体腘绳肌腱移植物（股薄肌和半腱肌）在分发前均经过 2.5 Mrad 的照射消毒，均来自于一个经过认证的组织库。78 例行关节镜 ACL 重建的患者连续前瞻性随机分为 2 组：自体移植物和照射同种异体移植物。所有手术均采用相同的外科技术，由同一位资深外科医生进行。术前和平均 42.2 个月的随访时，同一位观察者根据客观和主观临床评估对所有患者进行评估。
在 67 名患者（自体移植物组 36 名，照射同种异体移植物组 31 名）中，有 67 名患者接受了完整评估。在末次随访时，与自体移植物组相比，照射同种异体移植物组在 Lachman 试验、前抽屉试验、髌股关节试验和 KT-2000 关节测量仪（MEDmetric，圣地亚哥，CA）评估中，差异有统计学意义（P =.00011，P =.00016，P =.008，P =.00021）。最重要的是，根据 KT-2000 评估，自体移植物组 86.1%的患者和照射同种异体移植物组仅 32.3%的患者的侧间差值小于 3mm。照射同种异体移植物组的松弛率（侧间差值>5mm）（32.3%）高于自体移植物组（8.3%）。照射同种异体移植物组的前向和旋转稳定性明显下降。根据国际膝关节文献委员会的整体评分、功能和主观评估以及活动水平测试，2 组之间无统计学差异。然而，照射同种异体移植物组的手术时间较短，术后发热时间较长。当患者出现发热时，所有患者的实验室检查结果几乎正常（白细胞计数正常；红细胞沉降率 8 至 20mm/h；C 反应蛋白水平 4 至 11mg/L）。
自体腘绳肌腱 ACL 重建的临床结果令人满意，而两组之间仪器测量的松弛度差异显著，功能测试结果无显著差异。
Ⅱ级，前瞻性比较研究。
