Department of Orthopedic Surgery and Trauma, Pierre Paul Riquet University Hospital, Toulouse, France.
Department of Orthopedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier, France.
Knee Surg Sports Traumatol Arthrosc. 2020 Aug;28(8):2558-2566. doi: 10.1007/s00167-020-05873-1. Epub 2020 Feb 4.
Comparing scar cosmesis and regional hypoesthesia at the incision site between quadriceps tendon (QT), bone-patellar tendon-bone (BPTB), and hamstring tendon (HT) for anterior cruciate ligament (ACL) reconstruction.
Ninety patients undergoing ACL reconstruction with QT, HT or BPTB were evaluated at 1-year post-op. Scar cosmesis was assessed using the patient and observer scar assessment scale (POSAS) and length of the incision. Sensory outcome was analyzed by calculating the area of hypoesthesia around the scar. The classical ACL reconstruction functional follow-up was measured using the Lysholm score and KOOS.
Concerning QT versus BPTB group, QT patients have a significantly lower mean POSAS (24.8 ± 6.3 vs. 39.6 ± 5.8; p < 0.0001), shorter mean incision (2.8 ± 0.4 cm vs. 6.4 ± 1.3 cm; p < 0.0001), lower extent of hypoesthesia (8.7 ± 5.1 cm vs. 88.2 ± 57 cm; p < 0.0001), and better Lysholm score (90.1 ± 10.1 vs. 82.6 ± 13.5; n.s.). No significant difference was seen in KOOS (90.7 ± 7.2 vs. 88.4 ± 7.0; n.s.). Concerning QT versus HT group, no significant difference was found regarding mean POSAS score (24.8 ± 6.3 vs. 31.8 ± 6.2; n.s.), mean length of the incision (2.8 ± 0.4 cm vs. 2.5 ± 0.6 cm; n.s.), KOOS (90.7 ± 7.2 vs. 89.8 ± 8.2; n.s.) and mean Lysholm score (90.1 ± 10.1 vs. 87.8 ± 0.6; n.s.). The mean measured area of hypoesthesia was significantly higher in the HT group (70.3 ± 77.1 cm vs. 8.7 ± 5.1 cm; p < 0.0001).
Quadriceps tendon harvesting technique has the safest incision by causing less sensory loss compared to BPTB and HT. It also has the advantage of a short incision with more cosmetic scar compared to BPTB, with no difference compared to HT. However, no significant difference in terms of functional outcome was shown between the three autografts. These findings provide surgeons evidence about their clinical practice and help with graft choice decisions.
III.
比较股四头肌肌腱（QT）、骨-髌腱-骨（BPTB）和腘绳肌腱（HT）在前交叉韧带（ACL）重建中切口处的瘢痕美观和区域感觉减退情况。
90 例接受 ACL 重建的患者，术后 1 年进行评估，采用患者和观察者瘢痕评估量表（POSAS）和切口长度评估瘢痕美观，计算瘢痕周围感觉减退面积分析感觉减退情况。采用 Lysholm 评分和 KOOS 评估 ACL 重建的经典功能随访。
QT 与 BPTB 组相比，QT 患者的 POSAS 评分明显较低（24.8±6.3 比 39.6±5.8；p<0.0001），切口长度较短（2.8±0.4cm 比 6.4±1.3cm；p<0.0001），感觉减退范围较小（8.7±5.1cm 比 88.2±57cm；p<0.0001），Lysholm 评分较高（90.1±10.1 比 82.6±13.5；n.s.）。KOOS 评分无显著差异（90.7±7.2 比 88.4±7.0；n.s.）。QT 与 HT 组相比，POSAS 评分无显著差异（24.8±6.3 比 31.8±6.2；n.s.），切口长度（2.8±0.4cm 比 2.5±0.6cm；n.s.），KOOS（90.7±7.2 比 89.8±8.2；n.s.）和 Lysholm 评分（90.1±10.1 比 87.8±0.6；n.s.）均无显著差异。HT 组感觉减退的平均测量面积明显较高（70.3±77.1cm 比 8.7±5.1cm；p<0.0001）。
与 BPTB 和 HT 相比，股四头肌肌腱采集技术造成的感觉丧失最小，切口最安全。与 BPTB 相比，它还具有切口短、瘢痕美观的优点，与 HT 相比无差异。然而，三种自体移植物在功能结果方面没有显示出显著差异。这些发现为外科医生的临床实践提供了证据，并有助于移植物的选择决策。
III。
