Stensbirk Frederik, Thorborg Kristian, Konradsen Lars, Jørgensen Uffe, Hölmich Per
Arthroscopic Centre Amager, Amager Hospital, Copenhagen University Hospital, Italiensvej 1, 2300, Copenhagen S, Denmark,
Knee Surg Sports Traumatol Arthrosc. 2014 Sep;22(9):2094-101. doi: 10.1007/s00167-013-2630-9. Epub 2013 Aug 24.
The long-term results after using the iliotibial band autograft (ITB) in anterior cruciate ligament (ACL) reconstruction are not fully known. If equal in quality to conventional methods, the ITB graft could be a useful alternative as a primary graft, in revision surgery or multi-ligament reconstruction. The purpose is to assess whether the ITB autograft is a long-term reliable alternative to the bone-patella-tendon-bone (BPTB) autograft, using a prospective randomized controlled trial design.
From 1995 to 1996, sixty patients scheduled for primary ACL reconstruction were included in a prospective randomized controlled trial. Three senior knee surgeons, experienced in both types of ACL surgery, performed all the operations. A standardized and supervised rehabilitation programme was used for both groups for 6 months. Thirty patients received the ITB reconstruction, and 30 received the BPTB reconstruction. Forty-nine participated at follow-up in 2010 (82%). Primary outcome was the failure rate after ACL reconstruction. Secondary outcomes were knee injury osteoarthritis outcome score (KOOS) [pain, symptoms, Sport/Rec, quality of life (QOL), daily living function], Tegner activity scale, anterior knee pain-score, Lysholm score, Rolimeter laxity, extension deficit, single hop and crossover hop for distance.
At 15-year follow-up, no significant difference existed between the groups. Graft failure occurred in 4 ITB subjects (16%) and 3 BPTB subjects (13%). KOOS (Sport/Rec) for the ITB group was 75 and 73 for the BPTB group. The KOOS (QOL) was 72 and 68 for the ITB group and BPTB group, respectively.
Similar graft failure rates and KOOS were found when comparing ITB- and BPTB-operated individuals, at 15-year follow-up. The ITB graft had equal long-term clinical results compared to the BPTB graft and is recommended as a reliable alternative autograft for ACL reconstruction.
Therapeutic studies, Level I.
在前交叉韧带（ACL）重建中使用髂胫束自体移植（ITB）后的长期效果尚不完全清楚。如果质量与传统方法相当，ITB移植物可作为初次移植、翻修手术或多韧带重建中的一种有用替代物。目的是采用前瞻性随机对照试验设计评估ITB自体移植物是否是骨-髌腱-骨（BPTB）自体移植物的长期可靠替代物。
1995年至1996年，60例计划进行初次ACL重建的患者纳入一项前瞻性随机对照试验。三位在两种ACL手术方面均有经验的资深膝关节外科医生进行了所有手术。两组均采用标准化且有监督的康复计划，为期6个月。30例患者接受ITB重建，30例接受BPTB重建。2010年有49例（82%）参与随访。主要结局是ACL重建后的失败率。次要结局包括膝关节损伤骨关节炎结局评分（KOOS）[疼痛、症状、运动/娱乐、生活质量（QOL）、日常生活功能]、Tegner活动量表、膝前疼痛评分、Lysholm评分、Rolimeter松弛度、伸直受限、单腿跳和交叉腿跳距离。
在15年随访时，两组之间无显著差异。4例ITB组患者（16%）和3例BPTB组患者（13%）发生移植物失败。ITB组的KOOS（运动/娱乐）为75，BPTB组为73。ITB组和BPTB组的KOOS（QOL）分别为72和68。
在15年随访时，比较接受ITB和BPTB手术的个体，发现移植物失败率和KOOS相似。与BPTB移植物相比，ITB移植物具有同等的长期临床效果，推荐作为ACL重建的可靠替代自体移植物。
治疗性研究，I级。
