Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Clinic for Orthopedics and Trauma Surgery, Heidelberg University Hospital, Schlierbacher Landstrasse 200a, 69118, Heidelberg, Germany.
Center for Surgery B. Nimis and Dr. T. Sprinckstub, Zur Helde 4, 69168, Wiesloch, Germany.
Arch Orthop Trauma Surg. 2020 Oct;140(10):1465-1474. doi: 10.1007/s00402-020-03508-1. Epub 2020 Jun 5.
The use of quadriceps tendon-patellar bone (QTB) autograft for anterior cruciate ligament (ACL) reconstruction is gaining momentum. Yet, long-term results that compare this procedure with established methods are lacking. The aim of this study was to report and compare long-term results of ACL reconstruction using QTB autografts versus bone-patellar tendon-bone (BPTB) autografts, both anchored using a hardware-free press-fit fixation technique.
60 athletes (Tegner score ≥6) with primary ACL rupture were prospectively randomized into two groups. 56 patients were evaluated after a mean duration of 12.2 ± 1.9 months (range 10-14) and 43 patients after 10.3 ± 0.2 years (range 10-11).
On final follow-up, 90% of patients scored very good and good results in the functional Lysholm score (mean 99 ± 7.1, range 74-100 points). Normal or almost normal IKDC score was reported by 84% of the patients (mean 97 ± 9.5, range 60-100 points). The activity level decreased in the Tegner score from median of 7 before injury to 6 after 10 years. The KT-1000 arthrometer showed a difference in the anterior translation of less than 3 mm (mean 1.0 ± 1.2, range - 1 to 5 mm) in 91% of the patients. Significant degeneration was radiologically detected in one patient per group. No tunnel widening was seen in any patient. Up to 97% of all patients were satisfied with the operative procedure. No significant differences were found in the mentioned parameters between the two groups and also in comparison with the 1-year results. The only significant difference was in the donor site morbidity. Significantly more patients in the BPTB group had complaints during kneeling both at 1 (p < 0.001) and 10 years (p = 0.019). Squatting was also subjectively more problematic in the BPTB group than in the QTB group both after 1 (p = 0.003) and 10 years (p = 0.046).
This study shows equally good functional, clinical and radiological long-term results for both hardware-free methods of ACL reconstruction. These results clinically confirm the safety of press-fit anchoring after 10 years. The failure rate in this study was very low, with only one re-rupture in 10 years. The increased donor site morbidity when using the BPTB autograft compared to the QTB autograft supports already reported data. It was also seen in this study for the implant-free press-fit techniques.
Prospective and randomized, level of evidence 2.
使用四头肌腱-髌骨骨（QTB）自体移植物进行前交叉韧带（ACL）重建的方法正在逐渐普及。然而，目前还缺乏将这种方法与已有方法进行长期效果比较的研究。本研究旨在报告并比较使用 QTB 自体移植物与骨-髌腱-骨（BPTB）自体移植物进行 ACL 重建的长期结果，两种移植物均采用无固定装置的压配固定技术进行固定。
前瞻性随机将 60 名（Tegner 评分≥6）原发性 ACL 断裂的运动员分为两组。平均随访 12.2±1.9 个月（范围 10-14 个月）后，56 例患者得到了评估，平均随访 10.3±0.2 年（范围 10-11 年）后，43 例患者得到了评估。
末次随访时，90%的患者在功能 Lysholm 评分中获得了非常好和良好的结果（平均 99±7.1，范围 74-100 分）。84%的患者报告了正常或接近正常的 IKDC 评分（平均 97±9.5，范围 60-100 分）。Tegner 评分显示，受伤前的活动水平中位数为 7，10 年后降至 6。KT-1000 关节动度计显示，91%的患者的前向移动差值小于 3mm（平均 1.0±1.2，范围 -1 至 5mm）。在每组中都有 1 名患者存在明显的影像学退变。在任何患者中都没有观察到隧道增宽。高达 97%的患者对手术过程满意。两组之间以及与 1 年结果相比，在上述参数中均未发现显著差异。唯一的显著差异在于供区并发症。在 1 年（p<0.001）和 10 年（p=0.019）时，BPTB 组有更多患者在屈膝时存在抱怨。与 QTB 组相比，BPTB 组在 1 年（p=0.003）和 10 年（p=0.046）时，深蹲也更具主观性问题。
本研究显示，两种无固定装置的 ACL 重建方法在功能、临床和影像学方面均具有长期效果。这些结果从临床角度证实了压配固定 10 年后的安全性。本研究的失败率非常低，仅在 10 年内发生 1 例再断裂。与 QTB 自体移植物相比，使用 BPTB 自体移植物时供区并发症增加，这与已有数据一致。本研究也观察到了无固定装置压配技术的这种情况。
前瞻性、随机对照，证据水平 2。
