较厚的腘绳肌腱或髌腱移植物在减少年轻患者前交叉韧带重建中移植物失败率的效果。
Effectiveness of thicker hamstring or patella tendon grafts to reduce graft failure rate in anterior cruciate ligament reconstruction in young patients.
机构信息
Aguiléra Private Clinic, Ramsey générale de Santé, Department of Orthopaedics, Biarritz, France.
Department of Orthopaedics, Christchurch Hospital, Christchurch, New Zealand.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2021 Mar;29(3):725-731. doi: 10.1007/s00167-020-05973-y. Epub 2020 Apr 18.
PURPOSE
The purpose of this study was to determine the anterior cruciate ligament reconstruction (ACLR) failure rate in young patients utilizing the New Zealand (NZ) anterior cruciate ligament (ACL) Registry. The hypothesis was that the ACLR rupture rate would be lower for thicker hamstring graft and bone patellar tendon bone (BPB) grafts in comparison to the classic hamstring technique. The ACLR failure rate was assessed according to graft type and patients' sex.
METHODS
The NZ ACL registry was utilized to identify all patients aged 20 years or younger at the time of surgery who were skeletally mature and had a minimum 2-year follow-up. Graft ruptures, defined as an ACL revision, were identified according to graft type (traditional 4 strands hamstring semitendinosus and gracilis, 4 strands semitendinosus, 5-6 strands semitendinosus and gracilis, 7-8 strands semitendinosus and gracilis, bone-patella-bone graft).
RESULTS
Nine-hundred and ninety-two patients were included. At a mean follow-up of 38 months, 52 cases of graft rupture were recorded, (overall failure rate: 5.2%). The failure rate was not statistically influenced by the graft diameter. Patients with a thinner graft (< 8 mm-196 patients) had a similar failure rate (6%) to patients with a thicker graft (8 mm or more-485 patients) (6.2%). There was a lower failure rate in the BPB group (3.1%) versus all hamstrings group (6%) (ns). Finally, BPB in females had a lower failure rate than all hamstring constructs together (0% versus 5.1%; p = 0.023) CONCLUSION: In a young population traditional four-strand hamstring grafts, multiple strand configurations or BPB ACLR, whatever their size (> or < 8 mm), showed no significant difference in the failure rate in the NZ ACL registry. Female patients who had an ACL reconstruction with BPB graft had a significant lower failure rate than patients who had a hamstring graft.
LEVEL OF EVIDENCE
III.
目的
本研究旨在通过新西兰前交叉韧带（ACL）注册中心确定年轻患者前交叉韧带重建（ACLR）的失败率。假设较厚的腘绳肌腱移植物和骨髌腱骨（BPB）移植物的 ACLR 断裂率将低于经典的腘绳肌腱技术。根据移植物类型和患者性别评估 ACLR 失败率。
方法
利用新西兰 ACL 注册中心确定所有手术时年龄在 20 岁或以下、骨骼成熟且随访时间至少 2 年的患者。根据移植物类型（传统 4 股腘绳肌腱半腱肌和股薄肌、4 股半腱肌、5-6 股半腱肌和股薄肌、7-8 股半腱肌和股薄肌、骨-髌腱-骨移植物）确定 ACL 重建的移植物断裂。
结果
共纳入 992 例患者。平均随访 38 个月，记录到 52 例移植物断裂（总失败率为 5.2%）。移植物直径并未对失败率产生统计学影响。较细移植物（<8mm-196 例）的失败率（6%）与较厚移植物（8mm 或以上-485 例）相似（6.2%）（无统计学差异）。BPB 组（3.1%）的失败率低于所有腘绳肌组（6%）（无统计学差异）。最后，女性 BPB 的失败率低于所有腘绳肌结构的总和（0%比 5.1%；p=0.023）。
结论
在年轻人群中，传统的四股腘绳肌腱移植物、多股配置或 BPB ACLR，无论其大小（>8mm 或<8mm），在新西兰 ACL 注册中心的失败率均无显著差异。接受 BPB 移植物 ACLR 的女性患者的失败率明显低于接受腘绳肌腱移植物的患者。
证据水平
III。
Zotero 插件