Rush University Medical Center, Department of Orthopedic Surgery, Division of Sports Medicine, 1611 West Harrison Street, Suite 300, Chicago, IL 60612, USA.
Am J Sports Med. 2012 Jun;40(6):1347-54. doi: 10.1177/0363546512440685. Epub 2012 Mar 26.
There is little information regarding the incremental changes in the postoperative laxity of patellar tendon (PT) autografts versus allografts in anterior cruciate ligament (ACL) reconstruction.
(1) There would be no significant increase in laxity between 6 weeks and 1 year postoperatively with PT autografts or allografts, (2) there would be no significant difference in laxity between PT autografts and allografts, (3) there would not be a significant difference in laxity between nonirradiated and low dose-irradiated PT allograft tissues, and (4) the physical examination findings would correlate with the instrumented laxity outcomes.
Cohort study; Level of evidence, 3.
A retrospective review of 238 ACL-deficient patients who underwent single-incision endoscopic ACL reconstruction with a PT autograft (n = 132) or allograft (n = 106; 58 irradiated and 48 nonirradiated) from a single surgeon was made looking at data from preoperatively and from 6 weeks to 1 year postoperatively. The objective measurements of ligament integrity included range of motion, Lachman test, pivot-shift test, and KT-1000 arthrometer instrumented laxity examination. Failure was defined as arthrometric side-to-side differences (maximum manual difference) ≥3 mm or a positive pivot shift. Statistical significance was defined as P < .05.
There were no differences in postoperative examination findings or instrumented laxity between PT autografts and allografts (irradiated or nonirradiated) in either subgroup. The postoperative improvement based on the Lachman examination, pivot-shift test, and arthrometric data in all study groups was significant (P < .001) in 98% (autograft: n = 130; allograft: n = 104) of patients, and arthrometric failure correlated with failure by physical examination. There was no significant change in graft laxity, as measured by KT-1000 arthrometer, from 6 weeks to 1 year postoperatively for 98% of patients. Finally, there was no statistical correlation in instrumented laxity results for either the autograft or allograft group with reference to age, gender, concurrent meniscectomy, meniscal repairs, interval to surgery, postoperative patellar pain, time to surgery, or irradiated versus nonirradiated allograft.
Laxity is not increased after the initial 6 weeks for either PT allograft or autograft constructs during the first postoperative year. There was no correlation between age, gender, concomitant injury, interval to surgery, or radiation of the graft with instrumented laxity results. Furthermore, our arthrometric data paralleled our clinical findings of stability at follow-up.
关于前交叉韧带（ACL）重建中髌腱（PT）自体移植物与同种异体移植物术后松弛度的递增变化，相关信息较少。
（1）PT 自体移植物或同种异体移植物在术后 6 周至 1 年内不会出现明显的松弛度增加；（2）PT 自体移植物和同种异体移植物之间的松弛度无显著差异；（3）未辐照和低剂量辐照的 PT 同种异体移植物组织之间的松弛度无显著差异；（4）体格检查结果与仪器测量的松弛度结果相关。
队列研究；证据水平，3 级。
对 238 例由同一位外科医生行单切口关节镜 ACL 重建的 ACL 缺失患者进行回顾性分析，患者分别接受了 PT 自体移植物（n = 132）或同种异体移植物（n = 106；58 例辐照和 48 例未辐照）治疗，术前和术后 6 周至 1 年进行了随访。韧带完整性的客观测量包括活动度、lachman 试验、前抽屉试验和 KT-1000 关节测量仪测量的松弛度检查。失败定义为关节测量的侧间差异（最大手动差异）≥3mm 或前抽屉试验阳性。统计学意义定义为 P <.05。
在亚组中，PT 自体移植物和同种异体移植物（辐照或未辐照）之间的术后检查结果或仪器测量的松弛度均无差异。所有研究组中，lachman 检查、前抽屉试验和关节测量数据显示，术后 98%（自体移植物：n = 130；同种异体移植物：n = 104）患者的改善具有显著意义（P <.001），并且关节测量的失败与体格检查的失败相关。98%的患者在术后 6 周至 1 年期间，KT-1000 关节测量仪测量的移植物松弛度无明显变化。最后，自体移植物或同种异体移植物组的仪器测量松弛度结果与年龄、性别、同期半月板切除术、半月板修复、手术间隔、术后髌骨疼痛、手术时间或移植物的辐照与非辐照均无统计学相关性。
在术后最初 6 周内，PT 同种异体或自体移植物在术后第 1 年不会出现松弛度增加。年龄、性别、伴随损伤、手术间隔或移植物的辐照与仪器测量的松弛度结果之间无相关性。此外，我们的关节测量数据与随访时的稳定性临床发现相符。
