Sadeghpour Alireza, Ebrahimpour Adel, Attar Bahamin, Azizian Zahra
Department of Orthopaedic Surgery, Shohada Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Orthopaedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Res Med Sci. 2017 Sep 26;22:105. doi: 10.4103/jrms.JRMS_939_16. eCollection 2017.
The purpose of this study was to compare the outcomes of anterior cruciate ligament (ACL) reconstruction using the patellar versus hamstring tendon (HT) autograft.
In this randomized clinical trial, fifty patients undergoing arthroscopic ACL reconstruction were randomized into two equal groups: Those treated with either autogenous patellar tendon grafts (PT group) or HT group grafts. All patients were reviewed immediately after surgery, at 6 and 12 weeks after surgery, and then at 6 months using the International Knee Documentation Committee evaluation form. Infection, severity of pain (visual analog scale), duration of rehabilitation, and clinical and magnetic resonance imaging (MRI) findings were assessed at the 6-month follow-up. Positive pivot shift and Lachman test were considered clinical signs and symptoms of treatment failure. In addition, the absence of the ACL or transverse ACL rather than the posterior oblique ligament is an MRI finding that indicates treatment failure.
Comparing changes in pain and range of motion (ROM) in patients first and 6 months after therapy show that pain had been relief significantly ( < 0.001) and ROM dramatically changes ( < 0.001). The average rehabilitation period in the PT group was 13.2 ± 2.08 weeks whereas in the HT group, it was 9.28 ± 2.26 weeks. A significant difference was seen between the two groups in terms of the rehabilitation period ( < 0.001). No significant difference was found in the normal ROM between the groups ( = 0.32). When the pain severity was considered, a significant difference was found between the PT group and the HT group ( < 0.001). The HT group patients had less knee pain than did the PT group patients. No significant difference in infection rates was seen between two groups ( = 0.66).
Considering the better outcomes of HT reconstructions for the two parameters of pain severity and rehabilitation period, we consider HTs to be the ideal graft choice for ACL reconstructions.
本研究的目的是比较使用髌腱与腘绳肌腱（HT）自体移植物进行前交叉韧带（ACL）重建的效果。
在这项随机临床试验中，50例接受关节镜下ACL重建的患者被随机分为两组，每组人数相等：一组接受自体髌腱移植物治疗（PT组），另一组接受HT组移植物治疗。所有患者在术后立即、术后6周和12周以及术后6个月使用国际膝关节文献委员会评估表进行复查。在6个月随访时评估感染情况、疼痛严重程度（视觉模拟评分）、康复持续时间以及临床和磁共振成像（MRI）结果。阳性轴移试验和拉赫曼试验被视为治疗失败的临床体征和症状。此外，MRI显示ACL缺失或横行ACL而非后斜韧带是表明治疗失败的表现。
比较患者治疗后1个月和6个月时疼痛和活动范围（ROM）的变化，结果显示疼痛得到显著缓解（P<0.001），ROM有显著变化（P<0.001）。PT组的平均康复期为13.2±2.08周，而HT组为9.28±2.26周。两组在康复期方面存在显著差异（P<0.001）。两组之间正常ROM无显著差异（P=0.32）。考虑疼痛严重程度时，PT组和HT组之间存在显著差异（P<0.001）。HT组患者的膝关节疼痛比PT组患者少。两组之间感染率无显著差异（P=0.66）。
考虑到HT重建在疼痛严重程度和康复期这两个参数方面有更好的效果，我们认为HT是ACL重建的理想移植物选择。
