Su Mengdi, Jia Xinyu, Zhang Zaihang, Jin Zhigao, Li Yong, Dong Qirong, Xu Wei
Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
School of Medicine, Soochow University, Suzhou, Jiangsu, China; and.
Clin J Sport Med. 2021 Mar 1;31(2):e101-e110. doi: 10.1097/JSM.0000000000000730.
To compare the clinical efficacy of anterior cruciate ligament (ACL) reconstruction with 4-strand hamstring tendon autograft (4SHG), allograft and the Ligament Advanced Reinforcement System (LARS) ligament, and to find the causes of cumulative failure or nonreturn to sport.
Retrospective case series.
Department of Orthopedic Surgery, the second affiliated hospital of Soochow University, Suzhou, Jiangsu, China.
Three hundred six patients with isolated ACL deficiency were included. Two hundred twenty-nine patients met the inclusion/exclusion criteria, and finally, 185 of these patients participated in this study.
Anterior cruciate ligament reconstruction using 4SHG, allograft, and LARS.
Objective knee function, subjective knee function, and information regarding return to sport, cumulative failure, and complications. Secondary: distribution of tunnel position and tunnel enlargement.
There were no statistically significant differences between the 3 groups regarding all the clinical objective and subjective results, return to sport, complications, or cumulative failures (P > 0.05). One hundred twenty-eight patients (69.2%, 128/185) returned to sport. Preoperative (after injury) Tegner scores were inferior to postoperative Tegner scores, and postoperative Tegner scores were inferior to preinjury Tegner scores (P < 0.01). The femoral tunnel malposition was significantly associated with cumulative failure (P < 0.05).
There were no statistically significant differences among the 4SHG, allograft, and LARS ligament in terms of the clinical outcomes after ACL reconstruction (ACLR) at 5-years follow-up. Interestingly, ACLR could improve the functional and motorial level of the knee, but patients had great difficulty in regaining the level of preinjury movement. In addition, the malposition of the femoral tunnel was an important cause of cumulative failure.
比较四股腘绳肌腱自体移植（4SHG）、同种异体移植和韧带增强重建系统（LARS）韧带在前交叉韧带（ACL）重建中的临床疗效，并找出累积失败或无法恢复运动的原因。
回顾性病例系列研究。
中国江苏省苏州市苏州大学附属第二医院骨科。
纳入306例单纯ACL损伤患者。229例患者符合纳入/排除标准，最终185例患者参与本研究。
采用4SHG、同种异体移植和LARS进行前交叉韧带重建。
客观膝关节功能、主观膝关节功能以及有关恢复运动、累积失败和并发症的信息。次要指标：隧道位置分布和隧道扩大情况。
三组在所有临床客观和主观结果、恢复运动情况、并发症或累积失败方面均无统计学显著差异（P>0.05）。128例患者（69.2%，128/185）恢复运动。术前（受伤后）Tegner评分低于术后Tegner评分，且术后Tegner评分低于伤前Tegner评分（P<0.01）。股骨隧道位置不当与累积失败显著相关（P<0.05）。
在5年随访期，4SHG、同种异体移植和LARS韧带在前交叉韧带重建（ACLR）后的临床疗效方面无统计学显著差异。有趣的是，ACLR可改善膝关节的功能和运动水平，但患者恢复到伤前运动水平存在很大困难。此外，股骨隧道位置不当是累积失败的重要原因。
