Shelbourne K Donald, Beck Matthew B, Gray Tinker
Shelbourne Knee Center, Indianapolis, Indiana, USA
Orthopaedic Surgery Residency, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Am J Sports Med. 2015 Mar;43(3):648-53. doi: 10.1177/0363546514560877. Epub 2014 Dec 17.
Few surgeons use a contralateral patellar tendon autograft for primary anterior cruciate ligament (ACL) reconstruction because of concern for donor site morbidity.
There will be no difference in quadriceps muscle strength or International Knee Documentation Committee (IKDC) subjective scores in patients with contralateral grafts compared with patients with ipsilateral grafts.
Cohort study; Level of evidence, 3.
Between 2007 and 2009, a total of 279 patients who underwent primary ACL reconstruction with autogenous patellar tendon graft from the contralateral knee met the inclusion criteria of unilateral knee involvement, no arthritic changes preoperatively, and minimum 2-year follow-up objective and subjective evaluations. A control group was obtained of 58 patients who had the same inclusion criteria and were of the same age but who underwent surgery with ipsilateral graft. Patients underwent a goal-directed and sequential postoperative rehabilitation program that first emphasized controlling a hemarthrosis and obtaining full knee range of motion immediately after surgery, followed by increasing leg strength and performing functional activities. The rehabilitation for the contralateral donor site emphasized high-repetition/low-resistance exercises beginning the day after surgery. The IKDC subjective data were compared between surgery groups. Quadriceps muscle strength was evaluated in both knees compared with the preoperative values obtained in the noninvolved knee and between knees at 2 years postoperatively.
Quadriceps muscle strength compared with the preoperative normal value (mean ± SD) was 105% ± 29% in the ipsilateral ACL-reconstructed knee versus 114% ± 28.4% in the contralateral donor knee (P < .01) and 116% ± 25% in the contralateral ACL-reconstructed knee (P = .0339). Mean side-to-side strength (ACL-reconstructed knee/opposite knee) was 98.4% ± 13.6% in the contralateral group versus 92.9% ± 13.0% in the ipsilateral group (P < .01). The mean total IKDC score was 92.4 ± 9.6 for the contralateral donor knee. The mean IKDC total score for the ACL-reconstructed knee was 88.8 ± 12.3 in the contralateral group and 88.9 ± 11.2 in the ipsilateral group (P = .626).
After ACL reconstruction with contralateral patellar tendon graft, patients can achieve strength symmetry between legs after surgery without experiencing adverse subjective symptoms after graft harvest. Furthermore, strength return can be superior with a contralateral graft than with an ipsilateral graft.
由于担心供区并发症，很少有外科医生使用对侧髌腱自体移植物进行初次前交叉韧带（ACL）重建。
与使用同侧移植物的患者相比，使用对侧移植物的患者在股四头肌力量或国际膝关节文献委员会（IKDC）主观评分方面不会有差异。
队列研究；证据等级，3级。
2007年至2009年期间，共有279例接受对侧膝关节自体髌腱移植物进行初次ACL重建的患者符合纳入标准，即单侧膝关节受累、术前无关节炎改变，且有至少2年的随访客观和主观评估。选取58例具有相同纳入标准、年龄相同但接受同侧移植物手术的患者作为对照组。患者接受了目标导向且循序渐进的术后康复计划，该计划首先强调在术后立即控制关节积血并获得全膝关节活动范围，随后增加腿部力量并进行功能活动。对侧供区的康复从术后第一天开始强调高重复/低阻力锻炼。比较手术组之间的IKDC主观数据。与术前在未受累膝关节获得的值以及术后2年时双膝关节之间的值相比，评估双膝关节的股四头肌力量。
与术前正常值（均值±标准差）相比，同侧ACL重建膝关节的股四头肌力量为105%±29%，对侧供区膝关节为114%±28.4%（P <.01），对侧ACL重建膝关节为116%±25%（P =.0339）。对侧组的平均双侧力量（ACL重建膝关节/对侧膝关节）为98.4%±13.6%，同侧组为92.9%±13.0%（P <.01）。对侧供区膝关节的IKDC总评分均值为92.4±9.6。对侧组中ACL重建膝关节的IKDC总评分均值为88.8±12.3，同侧组为88.9±11.2（P =.626）。
在使用对侧髌腱移植物进行ACL重建后，患者术后可实现双腿力量对称，且取腱后无不良主观症状。此外，对侧移植物的力量恢复可能优于同侧移植物。
