Jacobs Cale A, Burnham Jeremy M, Makhni Eric, Malempati Chaitu S, Swart Eric, Johnson Darren L
Department of Orthopedics and Sports Medicine, University of Kentucky, Lexington, Kentucky, USA.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Am J Sports Med. 2017 Mar;45(4):892-899. doi: 10.1177/0363546516676079. Epub 2016 Dec 15.
Younger patients and those with smaller hamstring autograft diameters have been shown to be at significantly greater risk of graft failure after anterior cruciate ligament (ACL) reconstruction. To date, there is no information in the literature about the clinical success and/or cost-effectiveness of increasing graft diameter by augmenting with semitendinosus allograft tissue for younger patients.
Hybrid hamstring grafts are a cost-effective treatment option because of a reduced rate of graft failure.
Cohort study (economic and decision analysis); Level of evidence, 3.
We retrospectively identified patients younger than 18 years who had undergone ACL reconstruction by a single surgeon between 2010 and 2015. During this period, the operating surgeon's graft selection algorithm included the use of bone-patellar tendon-bone (BTB) autografts for the majority of patients younger than 18 years. However, hamstring autografts (hamstring) or hybrid hamstring autografts with allograft augment (hybrid) were used in skeletally immature patients and in those whom the surgeon felt might have greater difficulty with postoperative rehabilitation after BTB graft harvest. Patient demographics, graft type, graft diameter, the time the patient was cleared to return to activity, and the need for secondary surgical procedures were compared between the hamstring and hybrid groups. The clinical results were then used to assess the potential cost-effectiveness of hybrid grafts in this select group of young patients with an ACL injury or reconstruction.
This study comprised 88 patients (hamstring group, n = 46; hybrid group, n = 42). The 2 groups did not differ in terms of age, sex, timing of return to activity, or prevalence of skeletally immature patients. Graft diameters were significantly smaller in the hamstring group (7.8 vs 9.9 mm; P < .001), which corresponded with a significantly greater rate of graft failure (13 of 46 [28.3%] vs 5 of 42 [11.9%]; P = .049). As a result of the reduced revision rate, the hybrid graft demonstrated incremental cost savings of US$2765 compared with the hamstring graft, and the hybrid graft was the preferred strategy in 89% of cases.
Driven by increased graft diameters and the reduced risk of revision, hybrid grafts appear to be a more cost-effective treatment option in a subset of younger patients with an ACL injury.
研究表明，年轻患者以及腘绳肌自体移植物直径较小的患者在前交叉韧带（ACL）重建术后发生移植物失败的风险显著更高。迄今为止，文献中尚无关于通过使用半腱肌同种异体组织增大年轻患者移植物直径的临床成功率和/或成本效益的信息。
由于移植物失败率降低，混合腘绳肌移植物是一种具有成本效益的治疗选择。
队列研究（经济和决策分析）；证据等级，3级。
我们回顾性确定了2010年至2015年间由同一位外科医生进行ACL重建的18岁以下患者。在此期间，手术医生的移植物选择算法包括对大多数18岁以下患者使用骨-髌腱-骨（BTB）自体移植物。然而，对于骨骼未成熟的患者以及手术医生认为在BTB移植物采集后可能在术后康复方面有更大困难的患者，使用了腘绳肌自体移植物（腘绳肌组）或同种异体增强的混合腘绳肌自体移植物（混合组）。比较了腘绳肌组和混合组患者的人口统计学特征、移植物类型、移植物直径、患者获准恢复活动的时间以及二次手术的需求。然后利用临床结果评估混合移植物在这一特定的ACL损伤或重建年轻患者群体中的潜在成本效益。
本研究包括88例患者（腘绳肌组，n = 46；混合组，n = 42）。两组在年龄、性别、恢复活动时间或骨骼未成熟患者的比例方面没有差异。腘绳肌组的移植物直径明显更小（7.8对9.9 mm；P <.001），这与显著更高的移植物失败率相对应（46例中的13例[28.3%]对42例中的5例[11.9%]；P =.049）。由于翻修率降低，与腘绳肌移植物相比，混合移植物显示出成本节约增加了2765美元，并且在89%的病例中混合移植物是首选策略。
受移植物直径增加和翻修风险降低的驱动，混合移植物在一部分ACL损伤的年轻患者中似乎是一种更具成本效益的治疗选择。
