Department Of Orthopaedics, Government Medical College Hospital, Chandigarh, 160030, India.
Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2381-2388. doi: 10.1007/s00167-017-4790-5. Epub 2017 Nov 14.
To compare the results of bone-patellar tendon-bone graft (BPTB), semitendinosus-gracilis graft with preserved insertions (STGPI) and semitendinosus-gracilis-free graft (STGF) in terms of graft failure, objective mechanical stability, functional outcome, and return to sports in elite and recreational sports persons. It was hypothesized that the STGPI graft provided superior outcome as compared to the other two grafts.
Two hundred and forty-nine elite and recreational players who underwent ACL reconstruction surgery, with BPTB graft (N = 80), STGPI graft (N = 85), and STGF graft (N = 84) with a minimum follow-up of 2 years, were assessed using clinical tests, knee arthrometer (KT 1000™), single-leg hop test, Lysholm knee score, Tegner's activity scale, and return to sports. Groups were matched in terms of age, gender, mode of injury, side involved, the level of sports, associated injuries, and mean follow-up.
The median age of the patients was 24 years (range 16-46 years), with 227 males and 22 females, with a mean follow-up of 61.8 ± 25.9 months. At the final follow-up, the mean side-to-side difference by KT 1000™ was significantly superior in BPTB group (1.4 ± 2.1 mm) as compared to STGPI (1.9 ± 2.0 mm) and STGF group (2.5 ± 2.0 mm) (p = 0.002). The mean Lysholm knee score, Limb symmetry index (LSI) using single-leg hop test and the mean difference in pre-injury and post-surgery level of Tegner's activity scale were not significantly different. The rate of graft failure was significantly higher in STGF group (7.1%) as compared to BPTB (1.2%) and STGPI (1.2%) groups (p = 0.043).
BPTB graft is a better graft in terms of mechanical stability than STGPI and STGF grafts. STGPI graft and BPTB graft are superior to STGF graft in terms of graft failure rate. However, there is no statistically significant difference amongst the three grafts in terms of return to sports and clinical tests of instability. STGPI graft is another option in the clinical setting with low graft failure rate like that of BPTB graft and with the added advantage of not having significant donor site morbidity.
III.
比较骨-髌腱-骨（BPTB）移植物、保留止点的半腱肌-股薄肌腱（STGPI）移植物和游离半腱肌-股薄肌腱（STGF）移植物在精英和娱乐运动员中移植物失败、客观机械稳定性、功能结果和重返运动方面的结果。假设保留止点的半腱肌-股薄肌腱（STGPI）移植物的结果优于其他两种移植物。
249 名接受 ACL 重建手术的精英和娱乐运动员，使用 BPTB 移植物（N=80）、保留止点的半腱肌-股薄肌腱（STGPI）移植物（N=85）和游离半腱肌-股薄肌腱（STGF）移植物（N=84），随访至少 2 年，通过临床检查、膝关节测径仪（KT 1000™）、单腿跳跃测试、Lysholm 膝关节评分、Tegner 活动量表和重返运动进行评估。各组在年龄、性别、损伤方式、侧别、运动水平、合并损伤和平均随访方面进行匹配。
患者的中位年龄为 24 岁（范围 16-46 岁），男性 227 例，女性 22 例，平均随访 61.8±25.9 个月。在最终随访时，KT 1000™ 的侧间差异在 BPTB 组（1.4±2.1mm）明显优于 STGPI（1.9±2.0mm）和 STGF 组（2.5±2.0mm）（p=0.002）。单腿跳跃测试的 Lysholm 膝关节评分、肢体对称性指数（LSI）和术前与术后 Tegner 活动量表水平的平均差值均无显著差异。STGF 组（7.1%）的移植物失败率明显高于 BPTB 组（1.2%）和 STGPI 组（1.2%）（p=0.043）。
在机械稳定性方面，BPTB 移植物优于 STGPI 和 STGF 移植物。在移植物失败率方面，STGPI 移植物和 BPTB 移植物优于 STGF 移植物。然而，在重返运动和不稳定的临床检查方面，这三种移植物之间没有统计学上的显著差异。STGPI 移植物是另一种选择，具有与 BPTB 移植物相似的低移植物失败率，并且具有没有明显供体部位发病率的额外优势。
III。
