D'Alessandro Peter, Wake Giulia, Annear Peter
Department of Orthopaedics, Fremantle Hospital, Fremantle, Western Australia, Australia.
J Knee Surg. 2013 Apr;26(2):139-44. doi: 10.1055/s-0032-1324811. Epub 2012 Sep 10.
There is limited information in the literature regarding hamstring pain and muscle strains in patients following anterior cruciate ligament (ACL) reconstruction using hamstring autograft. We sought to investigate whether dividing hamstring tendons distal to the musculotendinous junction rather than forcefully stripping tendons away from the muscle belly during graft harvest resulted in a lower incidence of hamstring pain, muscle strains, and leg flexion strength deficit following commencement of sport-specific training postoperatively. Patients were randomized to either the "Cut" or "Push" groups of hamstring tendon harvesting. All other operative techniques were uniform. A total of 34 (cut = 20, push = 14) patients had a mean follow-up of 30 months, and assessments were conducted by a blinded single practitioner. A customized hamstring strain questionnaire and visual analogue pain score provided information for the study's primary focus: evaluation of postoperative hamstring pain and muscle strains. Leg flexion strength was also measured and a full knee assessment was conducted. The Cincinnati sports activity rating scale (SARS) was used to account for varying degrees of sporting participation and intensity since reconstruction. The "Cut" group's mean visual analogue score was 10.05 mm, significantly lower than the "Push" group (24.66 mm, p = 0.0398). The Cut group also recorded a significant reduction in the incidence of hamstring strains following ACL reconstruction (5/20 patients 25%) compared with the Push group (7/14 patients 50%, p = 0.045). There was no difference in leg flexion strength between the groups. Of the patients who reported hamstring strains, there was no significant difference in the mean Cincinnati SARS between the groups, nor any difference in overall knee function. The incidence of hamstring pain and muscle strains was significantly reduced in patients receiving the "cut" technique of harvesting hamstring tendons in ACL reconstruction surgery, a difference that was not attributable to a lower level of sporting activity.
关于使用自体腘绳肌进行前交叉韧带（ACL）重建的患者出现腘绳肌疼痛和肌肉拉伤的文献资料有限。我们试图研究，在获取移植物时，于肌腱-肌肉交界处远端切断腘绳肌腱，而非强行将肌腱从肌腹剥离，是否会导致术后开始专项运动训练后，腘绳肌疼痛、肌肉拉伤及腿部屈曲力量 deficit 的发生率更低。患者被随机分为腘绳肌腱获取的“切断”组或“推剥”组。所有其他手术技术均保持一致。共有34例患者（切断组 = 20例，推剥组 = 14例），平均随访30个月，评估由一名不知情的单一医生进行。一份定制的腘绳肌拉伤问卷和视觉模拟疼痛评分提供了有关该研究主要关注点的信息：术后腘绳肌疼痛和肌肉拉伤的评估。还测量了腿部屈曲力量，并进行了全膝关节评估。辛辛那提体育活动评分量表（SARS）用于考量自重建以来不同程度的体育参与和强度。“切断”组的平均视觉模拟评分为10.05毫米，显著低于“推剥”组（24.66毫米，p = 0.0398）。与“推剥”组相比，“切断”组在ACL重建后腘绳肌拉伤的发生率也显著降低（20例患者中有5例，占25%），而“推剥”组为（14例患者中有7例，占50%，p = 0.045）。两组之间的腿部屈曲力量没有差异。在报告有腘绳肌拉伤的患者中，两组之间的平均辛辛那提SARS没有显著差异，整体膝关节功能也没有差异。在ACL重建手术中接受“切断”技术获取腘绳肌腱的患者，腘绳肌疼痛和肌肉拉伤的发生率显著降低，这种差异并非归因于较低水平的体育活动。
