髌腱-骨移植取材后前膝疼痛。是确有其事还是被过度夸大了。
Anterior knee pain following BPTB graft harvest. Reality or overhyped.
作者信息
Mukhopadhyay Reetadyuti, Shah Nishith, Vakta Rohan, Bhatt Jaymin
机构信息
Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, India.
Aash Arthroscopy Centre, Ahmedabad, Gujarat, India.
出版信息
J Clin Orthop Trauma. 2018 Oct-Dec;9(4):307-311. doi: 10.1016/j.jcot.2018.03.003. Epub 2018 Mar 8.
INTRODUCTION
The patellar tendon graft has long been the gold standard for ACL reconstruction. Recently semitendinosus and gracilis tendons graft have been used increasingly. We hypothetise that the Bone-Patella Tendon-Bone graft is a good and economical graft for the Indian population with no adverse effects of anterior knee pain or patellar tendon shortening. We believe that the early squatting and cross-legged sitting causes early and constant stretching of the tendon in our patients. This is responsible for the lesser incidences of adverse effects in the Indian population.
MATERIAL AND METHOD
In a retrospective study, the hospital database was scrutinized to shortlist patients who had undergone a bone-patella tendon-bone harvest for ACL or PCL reconstruction before 2013. Each patient was evaluated using the Lysholm score and the KOOS Score. VAS was also used, to evaluate for the amount of pain experienced by patients. The analysis of the quadriceps power along with the presence or absence of any extensor lag was made too. The modified Insall Salvati index was also calculated.
RESULTS
Forty-seven patients were shortlisted of which 25 patients were followed up with an average follow up of 94.5 months. Although some patients did complain of occasional pain with the average VAS score of 1.45; on analyzing the data it was evident that all our patients had excellent quadriceps power (5/5) with no extensor lag. The mean Lysholm score was 95.55, while the mean KOOS score was 94.17. The mean Insall index of 1.05 showed no significant patella baja in any of our patients.
CONCLUSION
It is ascertained that no significant retro-patellar pain or shortening of the patellar tendon occurs following a bone patella tendon bone harvest. The bone patella bone tendon graft is a suitable graft for ligament reconstruction with good functional outcome, and no significant adverse effect of patella baja or anterior knee pain in the Indian patients.
LEVEL OF EVIDENCE
Level IV.
引言
髌腱移植长期以来一直是前交叉韧带（ACL）重建的金标准。最近，半腱肌和股薄肌腱移植的使用越来越多。我们推测，对于印度人群而言，骨-髌腱-骨移植是一种良好且经济的移植方式，不会产生膝前疼痛或髌腱缩短等不良反应。我们认为，早期蹲坐和盘腿坐会使我们患者的肌腱得到早期且持续的拉伸。这就是印度人群中不良反应发生率较低的原因。
材料与方法
在一项回顾性研究中，对医院数据库进行了审查，以筛选出2013年前接受过骨-髌腱-骨采集用于ACL或后交叉韧带（PCL）重建的患者。使用Lysholm评分和膝关节损伤与骨关节炎疗效评分（KOOS评分）对每位患者进行评估。还使用视觉模拟评分法（VAS）来评估患者所经历的疼痛程度。同时对股四头肌力量以及是否存在伸肌滞后进行了分析。还计算了改良的Insall Salvati指数。
结果
筛选出47例患者，其中25例患者接受了随访，平均随访时间为94.5个月。尽管一些患者确实抱怨偶尔有疼痛，平均VAS评分为1.45；但分析数据后发现，我们所有患者的股四头肌力量均优秀（5/5），且无伸肌滞后。Lysholm评分的平均值为95.55，而KOOS评分的平均值为94.17。平均Insall指数为1.05，表明我们的任何患者均未出现明显的髌低位。
结论
可以确定，骨-髌腱-骨采集后不会出现明显的髌后疼痛或髌腱缩短。骨-髌腱-骨移植是一种适合韧带重建的移植方式，功能结果良好，且在印度患者中不会产生明显的髌低位或膝前疼痛等不良反应。
证据级别
四级。
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