Okoroha Kelechi R, Keller Robert A, Jung Edward K, Khalil Lafi, Marshall Nathan, Kolowich Patricia A, Moutzouros Vasilios
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
School of Medicine, Wayne State University, Detroit, Michigan, USA.
Orthop J Sports Med. 2016 Dec 20;4(12):2325967116674924. doi: 10.1177/2325967116674924. eCollection 2016 Dec.
Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain.
To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone-patellar tendon-bone (BTB) versus hamstring tendon (HS) autograft.
Cohort study; Level of evidence, 2.
A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate. The primary outcome of the study was postoperative pain levels (visual analog scale), which were collected immediately after surgery and for 3 days postoperatively. Secondary outcome measures included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, reported breakthrough pain, and calls to the physician.
Patients treated with BTB had increased pain when compared with those treated with HS in the acute postoperative period (mean ± SD: day 0, 6.0 ± 1.7 vs 5.2 ± 2.0 [ = .066]; day 1, 5.9 ± 1.7 vs 4.9 ±1.7 [ = .024]; day 2, 5.2 ± 1.9 vs 4.1 ± 2.0 [ = .032]; day 3, 4.8 ± 2.1 vs 3.9 ± 2.3 [ = .151]). There were also significant increases in reported breakthrough pain (day 0, 76% vs 43% [ = .009]; day 1, 64% vs 35% [ = .003]) and calls to the physician due to pain (day 1, 19% vs 0% [ = .041]) in the BTB group. There were no significant differences in narcotic requirements or sleep disturbances. Overall, the BTB group reported significantly less satisfaction with pain management on days 0 and 1 ( = .024 and .027, respectively).
A significant increase in acute postoperative pain was found when performing ACL reconstruction with BTB compared with HS. Patients treated with BTB were more likely to have breakthrough pain, decreased satisfaction with their pain management, and to contact their physician due to pain. These findings suggest a difference in early postoperative pain between the 2 most common graft options for ACL reconstruction. Patients should be informed of the differences in acute postoperative pain when deciding on graft choice with their physician.
前交叉韧带（ACL）重建是一种常见的门诊手术，术后伴有明显疼痛。
确定采用骨-髌腱-骨（BTB）自体移植与腘绳肌腱（HS）自体移植进行ACL重建的患者在急性疼痛水平上的差异。
队列研究；证据等级，2级。
共有70例接受BTB或HS自体移植进行初次ACL重建的患者同意参与研究。研究的主要结局是术后疼痛水平（视觉模拟评分），在术后立即及术后3天收集。次要结局指标包括阿片类药物消耗量（静脉注射吗啡当量）、睡眠时间、患者满意度、报告的突破性疼痛以及致电医生的次数。
与HS治疗的患者相比，BTB治疗的患者在术后急性期疼痛加剧（平均值±标准差：第0天，6.0±1.7对5.2±2.0 [P = 0.066]；第1天，5.9±1.7对4.9±1.7 [P = 0.024]；第2天，5.2±1.9对4.1±2.0 [P = 0.032]；第3天，4.8±2.1对3.9±2.3 [P = 0.151]）。BTB组报告的突破性疼痛（第0天，76%对43% [P = 0.009]；第1天，64%对35% [P = 0.003]）以及因疼痛致电医生的次数（第1天，19%对0% [P = 0.041]）也显著增加。在麻醉需求或睡眠障碍方面无显著差异。总体而言，BTB组在第0天和第1天对疼痛管理的满意度显著较低（分别为P = 0.024和0.027）。
与HS相比，采用BTB进行ACL重建时术后急性疼痛显著增加。接受BTB治疗的患者更有可能出现突破性疼痛、对疼痛管理的满意度降低以及因疼痛联系医生。这些发现表明ACL重建的两种最常见移植物选择在术后早期疼痛方面存在差异。在与医生决定移植物选择时，应告知患者术后急性疼痛的差异。
