前交叉韧带移植物选择的变化及其随时间的变化。
Change in Anterior Cruciate Ligament Graft Choice and Outcomes Over Time.
机构信息
Jameson Crane Sports Medicine Institute, The Ohio State University, Columbus, Ohio, U.S.A.; Department of Orthopaedics, The Ohio State University, Columbus, Ohio, U.S.A..
Jameson Crane Sports Medicine Institute, The Ohio State University, Columbus, Ohio, U.S.A.
出版信息
Arthroscopy. 2017 Nov;33(11):2007-2014. doi: 10.1016/j.arthro.2017.06.019. Epub 2017 Aug 26.
PURPOSE
To analyze failure rate in 2-year increments to determine if graft choice changed over time and graft failure rate.
METHODS
A prospective 2002-2008 database was used to identify risk factors for anterior cruciate ligament (ACL) retear. Subjects who had primary ACL retear with no history of contralateral surgery and 2-year follow-up were included. Subjects who underwent a multiligament reconstruction were excluded. Graft type, age, sex, smoking status, body mass index, Marx activity level at index surgery, medial and lateral meniscus status at time of ACL retear, sport played after ACL reconstruction, and clinical site were evaluated. Analysis was repeated using 2002-2003 (early) and 2007-2008 (late) 2-year databases. Analysis of variance with post hoc analysis was performed to detect significant differences in age and Marx score by graft type over time.
RESULTS
Two-year follow-up for graft failure was obtained on 2,497 of 2,692 (93%) subjects. There were 112 of 2,497 (4.5%) ACL retears identified at 2-year follow-up. The only predictor that changed between early/late periods was allograft use. Allograft odds ratio decreased from 13.1 to 9.5 (P < .01). Allografts were used in older patients (31-40 years) and with lower Marx scores (10-8) from early to late periods. The mean age of subjects who received bone-patellar tendon-bone autografts did not significantly change over time (22.8-23.5). The mean age of subjects who received hamstring autografts fell (27.9-25.5). The mean age of subjects who received allografts rose significantly (31.3-39.8, P < .01). The mean Marx score of subjects who received bone-patellar tendon-bone and hamstring autografts did not significantly change over time. The mean Marx score of subjects who received allografts decreased significantly (P < .01).
CONCLUSIONS
After early recognition, allograft use in young active patients was a risk factor for retear; graft choice by surgeons changed in the late period to use of allografts in older and less-active patients, which correlated with a significant decrease in retear risk.
LEVEL OF EVIDENCE
Level III, case control study.
目的
分析每两年增加一次的失败率，以确定移植物的选择是否随时间发生变化以及移植物的失败率。
方法
使用前瞻性的 2002-2008 年数据库来确定前交叉韧带（ACL）再撕裂的危险因素。纳入了初次 ACL 再撕裂且无对侧手术史和 2 年随访的患者。排除了接受多韧带重建的患者。评估了移植物类型、年龄、性别、吸烟状况、体重指数、指数手术时的 Marx 活动水平、ACL 再撕裂时的内侧和外侧半月板状况、ACL 重建后从事的运动以及临床部位。使用 2002-2003 年（早期）和 2007-2008 年（晚期）的两年数据库重复了分析。通过移植物类型随时间的变化，进行方差分析和事后分析，以检测年龄和 Marx 评分的显著差异。
结果
2497 名 2692 名（93%）患者获得了 2 年的移植物失败随访。在 2 年随访时发现了 112 例（4.5%）ACL 再撕裂。早期和晚期之间唯一发生变化的预测因素是同种异体移植物的使用。同种异体移植物的优势比从 13.1 降至 9.5（P<.01）。同种异体移植物用于年龄较大的患者（31-40 岁）和 Marx 评分较低的患者（10-8）。接受骨-髌腱-骨自体移植物的患者的平均年龄随时间无显著变化（22.8-23.5）。接受腘绳肌自体移植物的患者的平均年龄下降（27.9-25.5）。接受同种异体移植物的患者的平均年龄显著升高（31.3-39.8，P<.01）。接受骨-髌腱-骨和腘绳肌自体移植物的患者的平均 Marx 评分随时间无显著变化。接受同种异体移植物的患者的平均 Marx 评分显著下降（P<.01）。
结论
在早期发现后，年轻活跃患者使用同种异体移植物成为再撕裂的危险因素；外科医生在后期改变了移植物的选择，使用同种异体移植物治疗年龄较大和活动较少的患者，这与再撕裂风险的显著降低相关。
证据水平
III 级，病例对照研究。
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