Mueske Nicole M, VandenBerg Curtis D, Pace J Lee, Katzel Mia J, Zaslow Tracy L, Padilla Ricardo A, Wren Tishya A L
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA.
Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd MS 69, Los Angeles, CA 90027, USA; Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
Knee. 2018 Dec;25(6):1065-1073. doi: 10.1016/j.knee.2018.09.005. Epub 2018 Sep 22.
Adolescent anterior cruciate ligament reconstruction (ACLR) commonly utilizes hamstring (HT), patellar (PT) or quadriceps (QT) tendon autografts, but consensus is lacking regarding optimal graft choice. This study compared landing biomechanics and asymmetries among ACLR patients with HT, PT and QT grafts and uninjured controls.
This retrospective study included 61 adolescents with unilateral ACLR (27 HT, 20 PT, 14 QT; four to 12 months post-surgery, mean 6.4; age 15.4, SD 1.4 years) and 27 controls (14.6, SD 0.9 years) who were evaluated during drop jump landings. Lower extremity 3D biomechanics and asymmetries were compared.
Compared to controls, all operative limbs exhibited 1) greater hip flexion and lower dorsiflexion angles; 2) higher hip and lower knee and ankle flexion moments; 3) higher energy absorption at the hip (HT and QT only) and lower at the knee and ankle; and 4) higher knee abduction moments. Asymmetries observed in all ACLR groups included 1) lower knee and ankle flexion angles; 2) lower knee and ankle flexion moments; 3) lower energy absorption at the knee and ankle; and 4) higher hip and knee abduction moments on the operative side. The PT and QT groups demonstrated greater asymmetry in hip and knee flexion moments compared to HT.
While adolescent ACLR limbs offloaded the knee and ankle, patients with PT or QT grafts demonstrated greater deficiencies during rehabilitation than those reconstructed with HT. Graft choice in ACLR should remain patient-specific and aim to optimize biomechanics with the ultimate goal of minimizing graft re-tear and donor site morbidity.
青少年前交叉韧带重建（ACLR）通常使用腘绳肌（HT）、髌腱（PT）或股四头肌（QT）肌腱自体移植物，但对于最佳移植物选择缺乏共识。本研究比较了接受HT、PT和QT移植物的ACLR患者与未受伤对照组之间的落地生物力学和不对称性。
这项回顾性研究纳入了61名单侧ACLR的青少年（27例HT、20例PT、14例QT；术后4至12个月，平均6.4个月；年龄15.4岁，标准差1.4岁）和27名对照组（14.6岁，标准差0.9岁），他们在单腿跳落地时接受了评估。比较了下肢的三维生物力学和不对称性。
与对照组相比，所有手术肢体均表现出：1）更大的髋关节屈曲和更小的背屈角度；2）更高的髋关节屈曲力矩以及更低的膝关节和踝关节屈曲力矩；3）髋关节更高的能量吸收（仅HT和QT）以及膝关节和踝关节更低的能量吸收；4）更高的膝关节外展力矩。在所有ACLR组中观察到的不对称性包括：1）更低的膝关节和踝关节屈曲角度；2）更低的膝关节和踝关节屈曲力矩；3）膝关节和踝关节更低的能量吸收；4）手术侧更高的髋关节和膝关节外展力矩。与HT相比，PT组和QT组在髋关节和膝关节屈曲力矩方面表现出更大的不对称性。
虽然青少年ACLR肢体减轻了膝关节和踝关节的负荷，但接受PT或QT移植物的患者在康复过程中表现出比接受HT重建的患者更大的功能缺陷。ACLR中的移植物选择应根据患者具体情况而定，旨在优化生物力学，最终目标是减少移植物再次撕裂和供区并发症。
