Cruz Christian A, Goldberg Daniel, Wake Jeffrey, Sy Joshua, Mannino Brian J, Min Kyong S, Bottoni Craig R
Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA.
Department of Orthopaedic Surgery, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA.
Orthop J Sports Med. 2020 Dec 4;8(12):2325967120970224. doi: 10.1177/2325967120970224. eCollection 2020 Dec.
Anterior cruciate ligament (ACL) reconstruction (ACLR) using bone-tendon-bone (BTB) autograft is associated with increased postoperative anterior knee pain and pain with kneeling and has the risk of intra- and postoperative patellar fracture. Additionally, graft-tunnel mismatch is problematic, often leading to inadequate osseous fixation. Given the disadvantages of BTB, an alternative is a bone-tendon autograft (BTA) procedure that has been developed at our institution. BTA is a patellar tendon autograft with the single bone plug taken from the tibia.
PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the short-term outcomes of BTA ACLR. We hypothesized that this procedure will provide noninferior failure rates and clinical outcomes when compared with a BTB autograft, as well as a lower incidence of anterior knee pain, pain with kneeling, and patellar fracture.
A consecutive series of 52 patients treated with BTA ACLR were retrospectively identified and compared with 50 age-matched patients who underwent BTB ACLR. The primary outcome was ACL graft failure, while secondary outcomes included subjective instability, anterior knee pain, kneeling pain, and functional outcome scores (Single Assessment Numeric Evaluation, Lysholm, and International Knee Documentation Committee subjective knee form).
At a mean follow-up of 29.3 months after surgery, there were 2 reruptures in the BTA cohort (4.0%) and 2 in the BTB cohort (4.0%). In the BTA group, 18% of patients reported anterior knee pain versus 36% of the BTB group ( = .04). A total of 22% of patients noted pain or pressure with kneeling in the BTA cohort, as opposed to 48% in the BTB cohort ( = .006). There were no differences in functional scores. In the BTA group, 94.2% of patients reported that their knees subjectively felt stable, as compared with 86% in the BTB group ( = .18).
This study demonstrated that the BTA ACLR leads to similarly low rates of ACL graft failure requiring revision surgery, with significantly decreased anterior knee pain and kneeling pain when compared with a BTB. Additionally, the potential complications of graft-tunnel mismatch and patellar fracture are eliminated with the BTA ACLR technique.
使用骨-肌腱-骨（BTB）自体移植物进行前交叉韧带（ACL）重建（ACLR）与术后膝关节前部疼痛增加、跪姿疼痛有关，并且存在术中及术后髌骨骨折的风险。此外，移植物-骨隧道不匹配也是个问题，常常导致骨固定不充分。鉴于BTB的这些缺点，我们机构开发了一种替代方法，即骨-肌腱自体移植物（BTA）手术。BTA是一种取自胫骨的单骨栓髌腱自体移植物。
目的/假设：本研究的目的是评估BTA ACLR的短期疗效。我们假设与BTB自体移植物相比，该手术的失败率和临床疗效不劣于BTB自体移植物，且膝关节前部疼痛、跪姿疼痛及髌骨骨折的发生率更低。
回顾性纳入连续52例行BTA ACLR治疗的患者，并与50例年龄匹配的接受BTB ACLR的患者进行比较。主要结局指标为ACL移植物失败，次要结局指标包括主观不稳定感、膝关节前部疼痛、跪姿疼痛及功能结局评分（单评估数字评价、Lysholm评分和国际膝关节文献委员会主观膝关节表）。
术后平均随访29.3个月，BTA组有2例再次断裂（4.0%），BTB组有2例再次断裂（4.0%）。在BTA组中，18% 的患者报告有膝关节前部疼痛，而BTB组为36%（P = 0.04）。BTA组共有22% 的患者指出跪姿时有疼痛或压痛，而BTB组为48%（P = 0.006）。功能评分无差异。BTA组中，94.2% 的患者报告其膝关节主观感觉稳定，而BTB组为86%（P = 0.18）。
本研究表明，BTA ACLR导致需要翻修手术的ACL移植物失败率同样较低，与BTB相比，膝关节前部疼痛和跪姿疼痛显著减轻。此外，BTA ACLR技术消除了移植物-骨隧道不匹配和髌骨骨折的潜在并发症。
