Calvo Rafael, Figueroa David, Figueroa Francisco, Vaisman Alex, Schmidt-Hebbel Andrés, Morales Nelson, Izquierdo Guillermo
Knee Unit, Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago, Chile.
Knee Unit, Hospital Dr. Sotero del Río, Santiago, Chile.
Arthroscopy. 2017 May;33(5):1007-1013. doi: 10.1016/j.arthro.2016.10.028. Epub 2017 Jan 9.
To compare the outcomes of 2 groups of patients undergoing anterior cruciate ligament (ACL) reconstruction: the first with a quadrupled semitendinosus gracilis (ST-G) autograft larger than 8 mm diameter and the second with a 5-strand ST-G autograft larger than 8 mm due to an insufficient diameter graft harvesting.
This was a retrospective study with 70 patients divided into 2 groups. Inclusion criteria included ACL ruptures of less than 3 months, ST-G ACL reconstructions, and final (4-strand or 5-strand) graft size larger than 8 mm. Exclusion criteria included multiligament knee injuries, meniscal or chondral pathology, ACL re-ruptures, inflammatory joint disease, or other procedures in the knee.
Group A comprised 33 patients with a quadruple ST-G graft, and group B comprised 37 patients with an insufficient graft diameter (<8 mm) in which a 5-strand graft was used. Mean age in group A was 29.7 (range 17-52) years and in group B was 30.6 (range 13-53) years (P = .78). Average follow-up in group A was 32.2 (range 24-48) months and in group B was 30.35 (range 24-48) months (P = .75). Average graft diameter in group A was 8.5 mm (range 8-10) and in group B when the graft was measured as quadruple was 7.2 mm (range 6.5-7.5) and 9.2 mm (range 8-10) when it was converted to 5-strand (P = .00596). Group A had 3 (9%) re-ruptures, and group B had 2 (5.4%) (P = .55). The average postoperative Lysholm score in group A was 93.3 (range 71-100) and in group B was 97.1 (range 80-100) (P = .79). Mean postoperative International Knee Documentation Committee in group A was 91 (range 75.9-100) and in group B was 96.8 (range 82-100) (P = .18).
In our study, the 5-strand hamstring autograft in ACL reconstruction was clinically comparable with the quadruple autograft larger than 8 mm. The differences in re-rupture and clinical outcomes were not statistically significant between the 2 groups, suggesting that it is a valid option when we have a graft of insufficient diameter.
Level III, retrospective comparative study.
比较两组接受前交叉韧带（ACL）重建的患者的治疗结果：第一组使用直径大于8毫米的四股半腱肌-股薄肌（ST-G）自体移植物，第二组因采集的移植物直径不足而使用直径大于8毫米的五股ST-G自体移植物。
这是一项回顾性研究，70例患者分为两组。纳入标准包括ACL损伤少于3个月、ST-G ACL重建以及最终（四股或五股）移植物尺寸大于8毫米。排除标准包括多韧带膝关节损伤、半月板或软骨病变、ACL再次断裂、炎性关节疾病或膝关节的其他手术。
A组包括33例使用四股ST-G移植物的患者，B组包括37例移植物直径不足（<8毫米）并使用五股移植物的患者。A组的平均年龄为29.7岁（范围17 - 52岁），B组为30.6岁（范围13 - 53岁）（P = 0.78）。A组的平均随访时间为32.2个月（范围24 - 48个月），B组为30.35个月（范围24 - 48个月）（P = 0.75）。A组的平均移植物直径为8.5毫米（范围8 - 10毫米），B组四股测量时为7.2毫米（范围6.5 - 7.5毫米），转换为五股时为9.2毫米（范围8 - 10毫米）（P = 0.00596）。A组有3例（9%）再次断裂，B组有2例（5.4%）（P = 0.55）。A组术后Lysholm评分平均为93.3（范围71 - 100），B组为97.1（范围80 - 100）（P = 0.79）。A组术后国际膝关节文献委员会评分平均为91（范围75.9 - 100），B组为96.8（范围82 - 100）（P = 0.18）。
在我们的研究中，ACL重建中使用的五股腘绳肌自体移植物在临床上与直径大于8毫米的四股自体移植物相当。两组之间再次断裂和临床结果的差异无统计学意义，这表明当移植物直径不足时，它是一个有效的选择。
III级，回顾性比较研究。
