在 2004 年至 2012 年对挪威前交叉韧带注册中心的 12643 名患者进行的研究中，与髌腱移植物相比，腘绳肌腱移植物在前交叉韧带重建后发生翻修的风险增加。
Increased risk of revision with hamstring tendon grafts compared with patellar tendon grafts after anterior cruciate ligament reconstruction: a study of 12,643 patients from the Norwegian Cruciate Ligament Registry, 2004-2012.
机构信息
Andreas Persson, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, Bergen, 5021 Norway.
出版信息
Am J Sports Med. 2014 Feb;42(2):285-91. doi: 10.1177/0363546513511419. Epub 2013 Dec 9.
BACKGROUND
The graft choice for anterior cruciate ligament reconstruction (ACLR) is controversial. Hamstring tendon (HT) autografts and patellar tendon (PT) autografts are the most common grafts used and have shown similar subjective and objective outcomes.
PURPOSE
To compare the revision rate between HT and PT autografts used in ACLR in Norway and to estimate the influence of patient age and sex.
STUDY DESIGN
Cohort study; Level of evidence, 2.
METHODS
The study included all patients who underwent primary ACLR without concomitant ligament injuries registered in the Norwegian Knee Ligament Registry from 2004 through 2012. The cohort was stratified by age group (15-19, 20-29, and ≥30 years) and autograft type (HT or PT). Revision rates at 1, 2, and 5 years were calculated using the Kaplan-Meier analysis, and hazard ratios (HRs) for revision were calculated using multivariate Cox regression models.
RESULTS
With a mean follow-up of 4.0 years, 12,643 primary ACLRs were identified, with 3428 PT and 9215 HT grafts, among which 69 revisions with PT grafts and 362 revisions with HT grafts were performed. The overall 5-year revision rate was 4.2%. A higher revision rate was recorded for HT versus PT grafts at all follow-up times. When adjusted for sex, age, and type of graft, the HR for revision was 2.3 (95% CI, 1.8-3.0) for HT grafts compared with PT grafts. The HR for revision in the youngest age group was 4.0 (95% CI, 3.1-5.2) compared with the oldest age group. Sex had no effect on the revision rate.
CONCLUSION
Patients with HT grafts had twice the risk of revision compared with patients with PT grafts. Younger age was the most important risk factor for revision, and no effect was seen for sex. Further studies should be conducted to identify the cause of the increased revision rate found for HT grafts.
背景
前交叉韧带重建（ACLR）的移植物选择存在争议。腘绳肌腱（HT）自体移植物和髌腱（PT）自体移植物是最常用的移植物，它们具有相似的主观和客观结果。
目的
比较挪威 ACLR 中使用 HT 和 PT 自体移植物的翻修率，并估计患者年龄和性别对翻修率的影响。
研究设计
队列研究；证据水平，2 级。
方法
该研究纳入了 2004 年至 2012 年间在挪威膝关节韧带登记处登记的所有接受单纯 ACLR 且无伴发韧带损伤的患者。该队列根据年龄组（15-19 岁、20-29 岁和≥30 岁）和自体移植物类型（HT 或 PT）进行分层。使用 Kaplan-Meier 分析计算 1、2 和 5 年的翻修率，使用多变量 Cox 回归模型计算翻修的风险比（HR）。
结果
平均随访 4.0 年后，共确定了 12643 例初次 ACLR，其中包括 3428 例 PT 和 9215 例 HT 移植物，其中 69 例 PT 移植物和 362 例 HT 移植物进行了翻修。总的 5 年翻修率为 4.2%。与 PT 移植物相比，HT 移植物在所有随访时间的翻修率均较高。当调整性别、年龄和移植物类型时，HT 移植物的翻修 HR 为 2.3（95%CI，1.8-3.0），而 PT 移植物的 HR 为 1.0。与最年长的年龄组相比，最年轻的年龄组的 HR 为 4.0（95%CI，3.1-5.2）。性别对翻修率没有影响。
结论
与 PT 移植物相比，HT 移植物的翻修风险增加了两倍。年龄较小是翻修的最重要危险因素，而性别没有影响。应进一步开展研究以确定 HT 移植物翻修率增加的原因。
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