Rothman Institute, Philadelphia, Pennsylvania, USA.
Am J Sports Med. 2019 Jul;47(9):2086-2092. doi: 10.1177/0363546519854762. Epub 2019 Jun 24.
Female athletes are 2 to 8 times more prone to anterior cruciate ligament (ACL) rupture than males. Furthermore, reinjury to the ipsilateral or contralateral knee can occur in >20% of athletes. Female sex and younger age are known risk factors for graft failure. The optimal graft choice for young females remains unknown and poorly studied.
PURPOSE/HYPOTHESIS: The authors aimed to compare clinical outcomes in young females who underwent ACL reconstruction (ACLR) with bone-patellar tendon-bone (BTB) and quadrupled hamstring (HS) autografts. It was hypothesized that no significant differences in outcomes exist between graft choices.
Cohort study; Level of evidence, 3.
Female patients aged 15 to 25 years who underwent primary ACLR with BTB or HS autograft were included for review. Patients were subdivided into 2 age groups: 15 to 20 years and 21 to 25 years. The occurrence of chondral, meniscal, or ligamentous injury to either knee was recorded for comparison.
A total of 256 females were included (BTB, n = 175; HS, n = 81). The majority of patients were between the ages of 15 and 20 years (BTB, 80%; HS, 77.8%). Overall, graft rupture occurred in 23 patients (9%) and contralateral ACL tear occurred in 18 (7%). Subgroup analysis showed that 75% of BTB and 100% of HS graft retears occurred in females aged 15 to 20 years. Within this age group, there was a significantly lower rate of graft ruptures in the BTB group (6.4%) as compared with the HS group (17.5%, = .02). Allograft augmentation was used in 4 of the 11 HS grafts that retore. When allograft-augmented grafts were excluded, there was no significant difference in graft failure rate between graft choices. Fifteen patients in the BTB group (12%) as opposed to 1 in the HS group (2%) reported extreme difficulty or the inability to kneel on the front of the knee ( = .04).
In females aged 15 to 20 years undergoing ACLR, BTB autograft may lead to fewer graft ruptures than HS autograft. While this difference was not observed in females aged 21 to 25 years, a larger sample may be required to accept the null hypothesis in this age group. BTB autograft significantly increased the risk of kneeling pain as compared with HS regardless of age.
女性运动员前交叉韧带（ACL）断裂的风险比男性高 2 至 8 倍。此外，>20%的运动员会出现同侧或对侧膝关节的再损伤。女性性别和年轻是移植物失败的已知危险因素。对于年轻女性来说，最佳的移植物选择仍然未知且研究不足。
目的/假设：作者旨在比较接受 ACL 重建（ACLR）的年轻女性使用骨-髌腱-骨（BTB）和四股腘绳肌腱（HS）自体移植物的临床结果。假设两种移植物选择之间不存在显著的结果差异。
队列研究；证据水平，3 级。
回顾性分析了接受 BTB 或 HS 自体移植物的年龄在 15 至 25 岁的女性患者。患者分为 2 个年龄组：15 至 20 岁和 21 至 25 岁。记录了两个膝关节的软骨、半月板或韧带损伤的发生情况进行比较。
共纳入 256 名女性（BTB，n = 175；HS，n = 81）。大多数患者年龄在 15 至 20 岁（BTB，80%；HS，77.8%）。总体而言，23 名患者（9%）发生移植物断裂，18 名患者（7%）发生对侧 ACL 撕裂。亚组分析显示，BTB 组中有 75%和 HS 组中有 100%的移植物再撕裂发生在年龄在 15 至 20 岁的女性中。在这个年龄组中，BTB 组的移植物断裂发生率明显低于 HS 组（6.4%比 17.5%，=.02）。11 个 HS 移植物中有 4 个使用同种异体移植物增强。排除同种异体增强移植物后，两种移植物选择的移植物失败率无显著差异。BTB 组有 15 名患者（12%）报告极度困难或无法在膝关节前侧跪下，而 HS 组只有 1 名患者（2%）（=.04）。
在年龄在 15 至 20 岁的接受 ACLR 的女性中，BTB 自体移植物可能导致比 HS 自体移植物更少的移植物断裂。然而，在年龄在 21 至 25 岁的女性中没有观察到这种差异，可能需要更大的样本量来接受该年龄组的零假设。与 HS 相比，BTB 自体移植物显著增加了屈膝疼痛的风险，而与年龄无关。
