Centre of Sports Orthopedics and Special Joint Surgery, Orthopedic Hospital Markgroeningen, Kurt-Lindemann-Weg 10, 71706, Markgroeningen, Germany.
Department of Orthopedics and Traumatology, Paracelsus Medical Private University, Clinic Nuremberg, Nuremberg, Germany.
Knee Surg Sports Traumatol Arthrosc. 2020 Aug;28(8):2572-2577. doi: 10.1007/s00167-020-05878-w. Epub 2020 Feb 4.
To determine and compare the incidence of post-operative septic arthritis following revision anterior cruciate ligament reconstruction (R-ACLR) with autologous quadriceps tendon (with patellar bone block) compared to autologous hamstring tendons (semitendinosus and gracilis).
A total of 1638 isolated R-ACLR with either autologous hamstring tendons (n = 1004, 61.3%) or quadriceps tendon (n = 634; 38.7%) were performed between 2004 and 2017 and were retrospectively analysed with regard to the occurrence of post-operative septic arthritis. The technique of R-ACLR did not significantly change during the years of the study. All patients received pre-op i.v.antibiotics, but no presoaking of the grafts in vancomycin was performed in the years of the study. The individual decision of graft choice was based on graft availability, tunnel position and the presence of tunnel widening. Generally, hamstring tendons were preferred. There were no clinically relevant differences between the groups regarding gender or age. Routine follow-up examination was performed 6 weeks after the index operation (follow-up rate 96.5%), and patients unsuspicious for septic arthritis at that time were classified as non-infected.
Fourteen patients with septic arthritis were identified, resulting in an overall incidence of 0.85%. There was one patient with septic arthritis in the quadriceps tendon group (incidence: 0.16%) and 13 patients in the hamstring tendons group (incidence: 1.29%), respectively. The difference was significant (p = 0.013).
In this series, the incidence of post-operative septic arthritis after R-ACLR was lower when quadriceps tendon graft was used compared to hamstring tendon grafts.
III.
比较和确定采用自体四头肌腱（带髌骨块）和自体腘绳肌腱（半腱肌和股薄肌）行翻修前交叉韧带重建术（R-ACLR）后发生术后感染性关节炎的发生率。
2004 年至 2017 年期间共行 1638 例孤立性 R-ACLR，其中 1004 例（61.3%）采用自体腘绳肌腱，634 例（38.7%）采用四头肌腱，回顾性分析术后感染性关节炎的发生情况。研究期间，R-ACLR 技术无明显变化。所有患者均接受术前静脉抗生素治疗，但本研究期间未对移植物进行万古霉素浸泡。移植物选择的个体决策基于移植物可用性、隧道位置和隧道增宽的存在。一般来说，更倾向于使用腘绳肌腱。两组间在性别或年龄方面无临床相关差异。术后 6 周进行常规随访检查（随访率 96.5%），当时无感染性关节炎可疑的患者被归类为未感染。
确定了 14 例感染性关节炎患者，总发生率为 0.85%。四头肌腱组有 1 例（发生率：0.16%），腘绳肌腱组有 13 例（发生率：1.29%），差异有统计学意义（p=0.013）。
在本系列中，与使用腘绳肌腱移植物相比，使用四头肌腱移植物行 R-ACLR 后术后感染性关节炎的发生率较低。
III 级。
