Children's Hospital Colorado, Aurora, Colorado, USA.
School of Medicine, University of Colorado, Aurora, Colorado, USA.
Am J Sports Med. 2019 Mar;47(3):560-566. doi: 10.1177/0363546518825255. Epub 2019 Feb 7.
The anterior cruciate ligament (ACL) repair technique avoids graft harvest and therefore the risk of donor site morbidity. However, early failure rates after ACL repair with suture ligament augmentation (SLA) remain high.
To compare surgical failure, functional outcomes, return to sport, and joint laxity between adolescents who underwent ACL repair with SLA and those who underwent ACL reconstruction with quadriceps tendon-patellar bone autograft (QPA).
Cohort study; Level of evidence, 3.
Adolescent patients (7-18 years old) underwent ACL repair with SLA or ACL reconstruction with QPA. The authors collected data from those who had postoperative information pertaining to repaired ligament or graft failure, range of motion, complications, and return to sport at a minimum of 6 months after surgery. Participants were contacted after surgery to complete study questionnaires.
The cohort included 22 consecutive patients in the SLA group and 157 in the QPA group. The median duration of follow-up was 2.7 years (interquartile range, 2.0-3.6 years) in the QPA group and 3.2 years (2.2-3.4 years) in the SLA group. After adjustment for sex, age, body mass index, and time from injury to surgery, the hazard of graft failure in the SLA group was 10.66 times (95% CI, 3.41-32.92; P < .0001) that of the QPA group. The cumulative incidence of graft failure in the first 3 years after surgery was 48.8% (95% CI, 28.9%-73.1%) in the SLA group, as opposed to 4.7% (2.1%-10.3%) in the QPA group. There was no difference in return to sport between the groups. Among individuals who did not rerupture their ACL, International Knee Documentation Committee and Lysholm scores were comparable between the groups, as well as range of motion.
The risk of failure was significantly increased in the SLA group relative to the QPA group. The high risk of failure for the SLA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury.
前交叉韧带（ACL）修复技术避免了移植物的采集，从而降低了供体部位发病率。然而，采用缝线韧带增强（SLA）技术修复 ACL 后的早期失败率仍然很高。
比较青少年患者采用 SLA 修复 ACL 与采用四头肌肌腱-髌骨骨自体移植物（QPA）重建 ACL 后的手术失败率、功能结果、重返运动情况和关节松弛度。
队列研究；证据等级，3 级。
对接受 ACL 修复 SLA 或 ACL 重建 QPA 的青少年患者进行回顾性研究。作者收集了术后与修复的韧带或移植物失败、关节活动度、并发症和术后至少 6 个月重返运动相关的信息。术后对患者进行随访以完成研究问卷调查。
SLA 组连续纳入 22 例患者，QPA 组纳入 157 例患者。QPA 组的中位随访时间为 2.7 年（四分位距，2.0-3.6 年），SLA 组为 3.2 年（2.2-3.4 年）。调整性别、年龄、体重指数和受伤至手术时间后，SLA 组移植物失败的风险是 QPA 组的 10.66 倍（95% CI，3.41-32.92；P<0.0001）。SLA 组术后 3 年内的移植物失败累积发生率为 48.8%（95% CI，28.9%-73.1%），而 QPA 组为 4.7%（2.1%-10.3%）。两组重返运动情况无差异。在未再次发生 ACL 断裂的患者中，两组的国际膝关节文献委员会和 Lysholm 评分、关节活动度无差异。
SLA 组的失败风险明显高于 QPA 组。在青少年 ACL 损伤患者的治疗选择中，应考虑 SLA 组在短期随访中存在较高的失败风险。
