Department of Orthopedic Surgery, Brown University, Providence, Rhode Island.
Department Medical Biostatistics, University of Vermont, Burlington, Vermont.
J Knee Surg. 2021 Jun;34(7):777-783. doi: 10.1055/s-0039-3402046. Epub 2020 Jan 21.
This article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone-tendon-bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity ("low-tension"; = 46) and (2) AP laxity overconstrained by 2 mm ("high-tension"; = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure. Outcomes included the Knee Injury and Osteoarthritis Outcome Score, Short-Form-36 (SF-36), and Tegner activity scale. Clinical outcomes included KT-1000S and International Knee Documentation Committee examination score; and functional outcomes included 1-leg hop distance and peak knee extensor torque. Imaging outcomes included medial joint space width, Osteoarthritis Research Society International radiographic score, and Whole-Organ Magnetic Resonance Score. There were significantly improved outcomes in the high-tension compared with the low-tension HS group for SF-36 subset scores for bodily pain ( = 0.012), social functioning ( = 0.004), and mental health ( = 0.014) 84 months postsurgery. No significant differences in any outcome were found within the BTB groups. Tegner activity scores were also significantly higher for the high-tension HS group compared with the low-tension (6.0 vs. 3.8, = 0.016). Patients with HS autografts placed in high tension had better outcomes relative to low tension for Tegner activity score and SF-36 subset scores for bodily pain, social functioning, and mental health. For this reason, we recommend that graft fixation be performed with the knee at 30-degree flexion ("high-tension" condition) when reconstructing the ACL with HS autograft.
这篇文章调查了前交叉韧带（ACL）重建患者 7 年以上的临床、功能和影像学结果，以确定使用髌腱（骨-腱-骨[BTB]）和腘绳肌腱（HS）自体移植物时，初始移植物张力对结果的影响。90 名患者接受 BTB 或 HS 重建，随机采用两种初始移植物张力方案：（1）正常前后（AP）松弛度（“低张力”；=46）和（2）AP 松弛度过度约束 2mm（“高张力”；=44）。72 名患者在 7 年内有数据可用，9 名患者因移植物失败而被排除。结果包括膝关节损伤和骨关节炎结果评分（Knee Injury and Osteoarthritis Outcome Score，KOOS）、SF-36 简短形式（Short-Form-36，SF-36）和 Tegner 活动量表。临床结果包括 KT-1000S 和国际膝关节文献委员会（International Knee Documentation Committee，IKDC）检查评分；功能结果包括单腿跳跃距离和峰值膝关节伸肌扭矩。影像学结果包括内侧关节间隙宽度、骨关节炎研究协会国际（Osteoarthritis Research Society International，OARSI）放射学评分和全器官磁共振评分。与低张力 HS 组相比，高张力 HS 组在术后 84 个月时 SF-36 身体疼痛亚组评分（=0.012）、社会功能（=0.004）和心理健康（=0.014）方面的结果明显改善。BTB 组之间在任何结果上均无显著差异。高张力 HS 组的 Tegner 活动评分也明显高于低张力组（6.0 比 3.8，=0.016）。与低张力相比，HS 自体移植物置于高张力下的患者的 Tegner 活动评分和 SF-36 身体疼痛、社会功能和心理健康亚组评分的结果更好。因此，我们建议在使用 HS 自体移植物重建 ACL 时，将膝关节固定在 30 度屈曲位（“高张力”状态）进行移植物固定。
