移植物直径和移植物类型与前交叉韧带重建的相关性：一项包括来自瑞典和挪威国家膝关节韧带登记处的 18425 名患者的队列研究。
Graft Diameter and Graft Type as Predictors of Anterior Cruciate Ligament Revision: A Cohort Study Including 18,425 Patients from the Swedish and Norwegian National Knee Ligament Registries.
机构信息
Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
出版信息
J Bone Joint Surg Am. 2019 Oct 16;101(20):1812-1820. doi: 10.2106/JBJS.18.01467.
BACKGROUND
It is important to investigate and compare graft diameters as well as graft types to identify risk factors for revision after an anterior cruciate ligament (ACL) reconstruction. We performed the current study in order to analyze the early ACL revision rate among patients treated with hamstring tendon (HT) autografts or patellar tendon (PT) autografts of different diameters. Our hypothesis was that an increase in both HT and PT autograft diameters would reduce the risk of early ACL revision.
METHODS
This retrospective study was based on prospectively collected data from the national knee ligament registries of Norway and Sweden and included patients who underwent primary ACL reconstruction during the period of 2004 through 2014. The primary end point was the 2-year incidence of ACL revision. The impact of graft type and diameter on the incidence of revision surgery was reported as relative risks (RRs) with 95% confidence intervals (CIs), estimated by using generalized linear models with a binomial distribution and log-link function.
RESULTS
Of 58,692 patients identified, a total of 18,425 patients were included in this study. The 2-year rate of ACL revision was 2.10% (PT autografts, 2.63%; HT autografts, 2.08%; RR = 0.93 [95% CI = 0.60 to 1.45]). There was an increased risk of ACL revision among patients treated with HT autografts with a diameter of <8 mm compared with larger HT autografts (RR = 1.25 [95% CI = 1.01 to 1.57]). Patients treated with HT autografts with a diameter of ≥9.0 mm or ≥10.0 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts.
CONCLUSIONS
Patients treated with larger-diameter HT autografts had a lower risk of early ACL revision compared with those treated with HT autografts of <8 mm. Patients treated with HT autografts of ≥9 or ≥10 mm had a reduced risk of early ACL revision compared with patients treated with PT autografts.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
研究和比较移植物直径以及移植物类型对于确定前交叉韧带（ACL）重建后翻修的风险因素非常重要。我们进行本项研究，旨在分析使用不同直径的腘绳肌腱（HT）自体移植物或髌腱（PT）自体移植物治疗的患者中 ACL 早期翻修率。我们的假设是，HT 和 PT 自体移植物直径的增加都会降低 ACL 早期翻修的风险。
方法
这是一项基于挪威和瑞典全国膝关节韧带注册中心前瞻性收集数据的回顾性研究，纳入了 2004 年至 2014 年期间接受初次 ACL 重建的患者。主要终点为 2 年 ACL 翻修发生率。使用二项分布和对数链接函数的广义线性模型报告移植物类型和直径对翻修手术发生率的影响，结果表示为相对风险（RR）及其 95%置信区间（CI）。
结果
在确定的 58692 名患者中，共有 18425 名患者纳入本研究。ACL 翻修的 2 年发生率为 2.10%（PT 自体移植物为 2.63%；HT 自体移植物为 2.08%；RR = 0.93[95%CI=0.60 至 1.45]）。与较大的 HT 自体移植物相比，直径＜8mm 的 HT 自体移植物患者 ACL 翻修风险增加（RR = 1.25[95%CI=1.01 至 1.57]）。与接受 PT 自体移植物治疗的患者相比，直径≥9.0mm 或≥10.0mm 的 HT 自体移植物患者 ACL 早期翻修风险降低。
结论
与直径＜8mm 的 HT 自体移植物相比，较大直径的 HT 自体移植物患者 ACL 早期翻修风险较低。与接受 PT 自体移植物治疗的患者相比，直径≥9 或≥10mm 的 HT 自体移植物患者 ACL 早期翻修风险降低。
证据等级
治疗性 III 级。有关证据水平的完整描述，请参见作者指南。
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