Hacken Brittney A, Keyt Lucas K, Leland Devin P, LaPrade Matthew D, Camp Christopher L, Levy Bruce A, Stuart Michael J, Krych Aaron J
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Orthop J Sports Med. 2020 Jun 12;8(6):2325967120925482. doi: 10.1177/2325967120925482. eCollection 2020 Jun.
Donor site morbidity after anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BTB) autograft is clinically significant, but evidence with contemporary techniques is lacking.
To (1) evaluate donor site morbidity at a single institution using modern techniques of BTB autograft harvest at 2-year follow-up, (2) develop a 10-question donor site morbidity instrument, and (3) compare this instrument against traditional outcome tools.
Case series; Level of evidence, 4.
We analyzed the 2-year follow-up outcomes of 200 consecutive patients who underwent ACL reconstruction with a BTB autograft performed by 2 surgeons at a single institution. The surgical technique utilized modern and consistent BTB autograft harvest, including graft sizing, patellar tendon and peritenon closure, and patellar and tibial donor site bone grafting. There were 187 patients included, with 13 patients undergoing revision ACL reconstruction excluded. An original 10-question scoring instrument evaluating donor site morbidity was administered to each patient (score, 0-100) and compared against each patient's International Knee Documentation Committee (IKDC) and Lysholm scores.
Overall, 13.9% of patients were noted to have anterior knee pain with activity at 2-year follow-up. Moreover, 3.7% of patients reported an inability to kneel on hard surfaces but had no problems on soft surfaces; 5.9% of patients reported mild discomfort but were able to kneel on all surfaces. Additionally, 75.4% of patients had a perfect (100/100) donor site morbidity score. The mean donor site morbidity score at 2-year follow-up was 98.3 ± 3.4. There was a very strong correlation between the IKDC and Lysholm scores but only a strong and moderate correlation when the donor site morbidity score was compared with the IKDC and Lysholm scores, respectively.
Donor site morbidity after ACL reconstruction with a BTB autograft was less frequent than reported in the existing literature. Some patients developed anterior knee pain; therefore, an informed discussion is advised. IKDC and Lysholm scores may not capture donor site symptoms after surgery. The 10-question donor site morbidity instrument may provide a more accurate assessment.
采用骨-髌腱-骨（BTB）自体移植物进行前交叉韧带（ACL）重建术后供区并发症具有临床意义，但缺乏当代技术相关的证据。
（1）在单中心使用现代BTB自体移植物获取技术，对2年随访时的供区并发症进行评估；（2）开发一种包含10个问题的供区并发症评估工具；（3）将该工具与传统结局评估工具进行比较。
病例系列；证据等级，4级。
我们分析了在单中心由2名外科医生为200例连续患者采用BTB自体移植物进行ACL重建的2年随访结果。手术技术采用现代且一致的BTB自体移植物获取方法，包括移植物尺寸测量、髌腱和腱周组织缝合以及髌骨和胫骨供区植骨。纳入187例患者，排除13例接受ACL翻修重建的患者。对每位患者使用一份原创的包含10个问题的评估供区并发症的评分工具（评分范围0 - 100），并与每位患者的国际膝关节文献委员会（IKDC）评分和Lysholm评分进行比较。
总体而言，在2年随访时，13.9%的患者在活动时有前膝疼痛。此外，3.7%的患者报告无法在硬地面上跪，但在软地面上无问题；5.9%的患者报告有轻度不适，但能够在各种地面上跪。另外，75.4%的患者供区并发症评分为满分（100/100）。2年随访时供区并发症平均评分为98.3 ± 3.4。IKDC评分和Lysholm评分之间有非常强的相关性，但供区并发症评分与IKDC评分和Lysholm评分分别比较时，仅具有强和中度相关性。
采用BTB自体移植物进行ACL重建术后供区并发症的发生率低于现有文献报道。部分患者出现了前膝疼痛；因此，建议进行充分的术前沟通。IKDC评分和Lysholm评分可能无法反映术后供区症状。包含10个问题的供区并发症评估工具可能提供更准确的评估。
