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女性在桥接增强前交叉韧带修复后具有更早的肌肉力量和功能恢复。

Females Have Earlier Muscle Strength and Functional Recovery After Bridge-Enhanced Anterior Cruciate Ligament Repair.

机构信息

Division of Sports Medicine, Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Department of Medical Biostatistics, University of Vermont, Burlington, Vermont, USA.

出版信息

Tissue Eng Part A. 2020 Jul;26(13-14):702-711. doi: 10.1089/ten.tea.2020.0057. Epub 2020 Jun 25.

Abstract

While a sex effect on outcomes following anterior cruciate ligament (ACL) reconstruction surgery has been previously documented, less is known following bridge-enhanced ACL repair (BEAR). We hypothesized that female sex would have significantly worse early functional outcomes and higher retear rates following primary repair of the ACL enhanced with a tissue-engineered scaffold. Sixty-five patients (28 males and 37 females), age 14-35 with a complete ACL tear underwent primary repair of the ACL enhanced with a tissue-engineered scaffold (bridge-enhanced ACL repair) within 45 days of injury. International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome (KOOS) scores, as well as instrumented anteroposterior (AP) laxity through KT-1000 testing and functional outcome measures were obtained at time points up to 2 years postoperatively and compared between males and females using mixed model repeated measures analyses and chi square tests. There was no significant sex difference on the postoperative IKDC Subjective Score at 3, 6, 12, or 24 months or any of the five KOOS scores at 12 and 24 months. Instrumented AP laxity testing demonstrated mean (standard deviation) side-to-side differences that were similar in the two sexes at 2 years; 1.7 (2.7) mm and 1.5 (3.7) mm in females and males, respectively,  = 0.72. At 6 months postoperatively, males had a larger deficit in hamstring strength on the operated leg (14.0% vs. 1.7%;  = 0.03) and a larger deficit in quadriceps strength on the operated leg (11.3% vs. 2.0%;  = 0.004); however, no sex difference was noted at 12 or 24 months. Females demonstrated superior single leg hop testing at 6 and 12 months ([91.3% vs. 78.1%,  = 0.001], [96.9% vs. 87.0%,  = 0.01] respectively). There were no significant sex differences on ipsilateral (males; 14.3% vs. females; 13.9%,  = 1.00) or contralateral (males; 3.6% vs. females; 2.8%,  = 1.00) ACL reinjury rates. Female subjects had better hamstring and quadriceps strength indices at 6 months than males as well as better hop test results at the 6 and 12-month time period. Despite this, there was no significant sex difference on patient-reported outcomes and objective AP laxity testing at time points up to 2 years postoperatively. Impact statement This is the first study comparing sex specific outcomes following the bridge-enhanced ACL repair technique (BEAR). The results of this study suggest that females have earlier recovery of both muscle strength and functional outcomes compared to their male counterparts. This is an important finding when considering future modifications to postoperative care and rehabilitation in females and males following this tissue-engineered BEAR technique.

摘要

虽然先前已有研究证明性别对前交叉韧带(ACL)重建手术后的结果有影响,但在桥接增强 ACL 修复(BEAR)后,性别对结果的影响则知之甚少。我们假设,在使用组织工程支架增强的 ACL 进行初次修复后,女性的早期功能结果会显著更差,且再撕裂率更高。

65 名患者(28 名男性和 37 名女性),年龄 14-35 岁,ACL 完全撕裂,受伤后 45 天内行 ACL 增强的初次修复(桥接增强 ACL 修复)。通过 KT-1000 测试和功能结果测量,在术后时间点获得国际膝关节文献委员会(IKDC)和膝关节损伤和骨关节炎结果(KOOS)评分,以及仪器化前后(AP)松弛度,并使用混合模型重复测量分析和卡方检验比较男性和女性之间的差异。

在术后 3、6、12 和 24 个月的 IKDC 主观评分或术后 12 和 24 个月的五个 KOOS 评分中,性别间无显著差异。仪器化的 AP 松弛测试显示,2 年后两性之间的侧间差异相似;女性为 1.7(2.7)mm,男性为 1.5(3.7)mm, = 0.72。术后 6 个月时,男性在患腿的腘绳肌力量上存在更大的缺陷(14.0%比 1.7%, = 0.03),在患腿的股四头肌力量上存在更大的缺陷(11.3%比 2.0%, = 0.004);然而,在 12 个月和 24 个月时,性别差异并不明显。女性在 6 个月和 12 个月时的单腿跳跃测试表现更优([91.3%比 78.1%, = 0.001],[96.9%比 87.0%, = 0.01])。同侧(男性:14.3%比女性:13.9%, = 1.00)或对侧(男性:3.6%比女性:2.8%, = 1.00)ACL 再损伤率在性别间无显著差异。

女性在 6 个月时的腘绳肌和股四头肌力量指数优于男性,在 6 个月和 12 个月时的跳跃测试结果也优于男性。尽管如此,在术后长达 2 年的时间内,在患者报告的结果和客观的 AP 松弛测试方面,性别间无显著差异。

研究意义

这是第一项比较桥接增强 ACL 修复技术(BEAR)后性别特异性结果的研究。本研究结果表明,与男性相比,女性的肌肉力量和功能结果更早恢复。当考虑对接受这种组织工程 BEAR 技术治疗的女性和男性进行术后护理和康复的未来改进时,这是一个重要的发现。

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