缝线增强与标准前交叉韧带重建：一项匹配的对比分析。
Suture Augmented Versus Standard Anterior Cruciate Ligament Reconstruction: A Matched Comparative Analysis.
机构信息
Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A..
Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, DC, U.S.A.
出版信息
Arthroscopy. 2019 Jul;35(7):2114-2122. doi: 10.1016/j.arthro.2019.01.054. Epub 2019 Jun 2.
PURPOSE
To compare outcomes between standard anterior cruciate ligament reconstruction (ACLR) using hamstring grafts with and without suture augmentation (SA).
METHODS
Patients who underwent ACLR with hamstring autografts or allografts with minimum 2-year follow-up were retrospectively reviewed. Patients undergoing ACLR with SA were matched 1:1 by age, gender, body mass index, graft type, and revision status to standard ACLR. Range of motion, pain, postoperative activity, patient-reported outcome measures (PROMs), and complications were collected. Paired 2-tailed Student's t-tests and Pearson's χ-tests were used for continuous and categorical variables, respectively. A multivariate analysis of variance was conducted. Return to preinjury activity level was assessed using Spearman's rho and Pearson's χ-tests.
RESULTS
Sixty patients at a mean age of 29.50 ± 6.60 years, 43.4% male, body mass index 26.27 ± 3.37, and follow-up of 29.54 ± 5.37 months were included. Preoperative PROMs were not significantly different (P >. 05). Postoperative range of motion was similar between groups (P = .457). Postoperative average daily (0.60 ± 1.25 vs 1.66 ± 1.90) and maximum daily pain (1.57 ± 1.83 vs 3.35 ± 2.28) were significantly lower for SA (P < .014). SA predicted improvement in PROMs (P < .05) and maximum pain scores (P = .001). SA was significantly correlated with improved time to return to preinjury activity level (9.17 ± 2.06 vs 12.88 ± 3.94 months; P = .002) and percentage of preinjury activity level (93.33% ± 13.22% vs 83.17% ± 17.69%; P = .010). There was a trend toward improved rate of return to preinjury activity level for SA (76.7% vs 56.7%; P = .100).
CONCLUSIONS
Our study demonstrates that SA hamstring ACLRs were associated with improved PROMs, less pain, and a higher percentage of and earlier return to preinjury activity level when compared with standard hamstring ACLRs without evidence of overconstraint.
LEVEL OF EVIDENCE
Level III, retrospective comparative study.
目的
比较使用和不使用缝线增强（SA）的标准前交叉韧带重建（ACLR）术后结果。
方法
回顾性分析接受 ACLR 治疗的患者，采用自体或同种异体肌腱，随访时间至少 2 年。通过年龄、性别、体重指数、移植物类型和翻修状态与标准 ACLR 进行 1:1 匹配，接受 ACLR 合并 SA 的患者。收集运动范围、疼痛、术后活动、患者报告的结果测量（PROM）和并发症。连续变量采用配对双侧学生 t 检验，分类变量采用 Pearson χ 检验。采用方差分析进行多变量分析。使用 Spearman's rho 和 Pearson χ 检验评估恢复到术前活动水平的情况。
结果
共纳入 60 名患者，平均年龄 29.50±6.60 岁，43.4%为男性，体重指数 26.27±3.37，随访时间 29.54±5.37 个月。术前 PROM 无显著差异（P＞.05）。两组术后运动范围相似（P＝.457）。SA 术后平均日常（0.60±1.25 比 1.66±1.90）和最大日常疼痛（1.57±1.83 比 3.35±2.28）明显较低（P＜.014）。SA 预测 PROM 和最大疼痛评分的改善（P＜.05）。SA 与恢复术前活动水平的时间（9.17±2.06 比 12.88±3.94 个月；P＝.002）和术前活动水平的百分比（93.33%±13.22%比 83.17%±17.69%；P＝.010）呈显著正相关。SA 有较高的恢复术前活动水平的趋势（76.7%比 56.7%；P＝.100）。
结论
本研究表明，与标准的 ACLR 相比，SA 联合自体或同种异体肌腱 ACLR 术后患者的 PROM、疼痛减轻、术前活动水平的恢复率和百分比均有改善，且无过度约束的证据。
证据等级
III 级，回顾性比较研究。
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