翻修前交叉韧带重建术中使用自体髌腱移植物优于同种异体髌腱移植物的高重返运动率。
Superior return to sports rate after patellar tendon autograft over patellar tendon allograft in revision anterior cruciate ligament reconstruction.
机构信息
Center for Human Movement Science, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Centre for Orthopaedic Surgery OCON, Hengelo, The Netherlands.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2018 Feb;26(2):574-581. doi: 10.1007/s00167-017-4612-9. Epub 2017 Jun 17.
PURPOSE
After revision anterior cruciate ligament reconstruction (ACLR), the rate of return to the pre-injury type of sport (RTS type) is low and graft choice might be an important factor. The aim of this study was to determine whether there is a difference in outcome after revision ACLR using a patellar tendon allograft compared to an ipsilateral patellar tendon autograft. It was hypothesized that the rate of RTS type using an ipsilateral patellar tendon autograft will be superior to using patellar tendon allograft.
METHODS
The design is a retrospective cohort study. Inclusion criteria were patients who underwent revision ACLR with a minimum follow-up of 1 year after revision using a patellar allograft or ipsilateral autograft. Primary study parameter was rate of RTS type. Secondary study parameters were RTS level, subscores of the KOOS, the IKDC, the Tegner score and reasons for no RTS.
RESULTS
Eighty-two patients participated in this study (36 allografts and 46 autografts). In patients with a minimum follow-up of 1 year, rate of RTS type was 51.4% for the patellar tendon allograft and 62.8% for the patellar tendon autograft group (n.s.). In patients with a minimum follow-up rate of 2 years, rate of RTS type was 43.3 versus 75.0%, respectively (p = 0.027). No differences in secondary study parameters were found. In patients with a minimum follow-up of 1 year, rate of RTS type was significantly higher (p = 0.025) for patients without anxiety compared to patients who were anxious to perform certain movements.
CONCLUSION
After a minimum follow-up of 2 years, rate of RTS type is in favour of using an ipsilateral patellar tendon autograft when compared to using a patellar tendon allograft in patients undergoing revision ACLR; after a minimum follow-up of 1 year, no significant difference was found. In revision ACLR, the results of this study might influence graft choice in favour of autologous graft when the use of an allograft or autograft patellar tendon is considered.
LEVEL OF EVIDENCE
III.
目的
前交叉韧带重建（ACLR）后，重返术前运动类型（RTS 类型）的比例较低，移植物的选择可能是一个重要因素。本研究的目的是确定使用髌腱同种异体移植物与使用同侧髌腱自体移植物进行翻修 ACLR 后结果是否存在差异。假设使用同侧髌腱自体移植物进行 RTS 类型的比例将优于使用髌腱同种异体移植物。
方法
本设计为回顾性队列研究。纳入标准为接受翻修 ACLR 的患者，至少在翻修后 1 年进行了随访，使用髌腱同种异体移植物或同侧自体移植物。主要研究参数是 RTS 类型的比例。次要研究参数是 RTS 水平、KOOS 亚量表、IKDC、Tegner 评分和未进行 RTS 的原因。
结果
82 名患者参与了本研究（36 例同种异体移植物和 46 例自体移植物）。在至少随访 1 年的患者中，髌腱同种异体移植物组的 RTS 类型比例为 51.4%，而髌腱自体移植物组为 62.8%（无统计学差异）。在至少随访 2 年的患者中，RTS 类型比例分别为 43.3%和 75.0%（p=0.027）。在次要研究参数方面没有发现差异。在至少随访 1 年的患者中，与焦虑的患者相比，无焦虑的患者 RTS 类型的比例显著更高（p=0.025）。
结论
在至少 2 年的随访后，与使用髌腱同种异体移植物相比，对于接受翻修 ACLR 的患者，使用同侧髌腱自体移植物进行 RTS 类型的比例更有利；在至少 1 年的随访后，未发现显著差异。在翻修 ACLR 中，当考虑使用同种异体移植物或自体髌腱移植物时，本研究的结果可能会影响移植物的选择，偏向使用自体移植物。
证据等级
III。
Zotero 插件