Service de chirurgie osseuse, centre hospitalier universitaire (CHU) d'Angers, 4, rue Larrey, 49000 Angers, France; Service de chirurgie orthopédique et traumatologique, centre hospitalier du Haut Anjou, 1, quai du Dr-Lefèvre, 53200 Château-Gontier-sur-Mayenne, France.
Service de chirurgie orthopédique et traumatologique, centre hospitalier, 20, boulevard Général-Maurice-Guillaudot, 56000 Vannes, France.
Orthop Traumatol Surg Res. 2022 May;108(3):102832. doi: 10.1016/j.otsr.2021.102832. Epub 2021 Feb 5.
The number of anterior cruciate ligament (ACL) reconstructions is steadily rising in France. Re-tear rates of up to 25% have been reported and graft selection remains a notable challenge. Allografts, although rarely used in France, can be a viable option. The primary objective of this study was to demonstrate the benefits of ACL revision with allografts, by determining subjective scores (IKDC score and KOOS), measuring laxity, and evaluating the rate of return to sports.
Tendon allografts are reliable and can be used in France for ACL reconstruction revision.
We conducted a retrospective study including 39 patients managed in two centres between 2004 and 2016 and followed up for at least a year. Patients were eligible if they had undergone tendon allograft reconstruction for ACL revision with or without rupture of a peripheral plane. We excluded underage patients and patients with a history of ligament injury in the contralateral knee. Mean age was 32 years. The allografts were extensor mechanisms, anterior or posterior tibial tendons, fascia lata tendons, hamstring tendons, and a short fibular tendon. They were obtained from French and Belgian tissue banks. They were used for the reconstruction of 39 ACLs and 11 collateral ligaments. The IKDC score and KOOS were determined in all patients. Laximetry was performed in 31 patients by an independent examiner.
Mean follow-up was 3.5 years. Arthroscopic release was required in one patient, and 2 patients experienced re-tears. No deep surgical site infections were recorded. The subjective IKDC score and the KOOS improved significantly, from 53.6 to 80.7 and from 60.4 to 83.2, respectively. Mean postoperative differential laxity was 1.4mm (KT 1000) and 1.6mm (GNRB®). Of the 3 patients who were professional athletes, 2 had returned to sports at the same level one year later, and among the recreational athletes, 54% had resumed their previous sporting activities.
In the setting of complex ligament reconstruction revision, tendon allografts are reliable and can be used in France.
IV; retrospective cohort study.
法国前交叉韧带（ACL）重建的数量稳步上升。据报道，再撕裂率高达 25%，而移植物的选择仍然是一个显著的挑战。同种异体移植物虽然在法国很少使用，但可能是一种可行的选择。本研究的主要目的是通过确定主观评分（IKDC 评分和 KOOS）、测量松弛度以及评估重返运动的比例，来证明 ACL 翻修时使用同种异体移植物的益处。
同种异体肌腱移植物是可靠的，可以在法国用于 ACL 重建翻修。
我们进行了一项回顾性研究，纳入了 2004 年至 2016 年间在两个中心接受治疗且随访至少 1 年的 39 例患者。如果患者接受同种异体肌腱重建 ACL 翻修，且伴有或不伴有外周平面撕裂，则符合入组条件。我们排除了未成年患者和对侧膝关节有韧带损伤史的患者。平均年龄为 32 岁。同种异体移植物为伸肌机制、前或后胫骨肌腱、阔筋膜肌腱、腘绳肌腱和腓骨短肌腱，均来自法国和比利时的组织库。同种异体移植物用于重建 39 个 ACL 和 11 个侧副韧带。所有患者均进行了 IKDC 评分和 KOOS 评分。31 例患者由独立评估者进行松弛度测量。
平均随访时间为 3.5 年。1 例患者需要关节镜下松解，2 例患者出现再撕裂。未记录到深部手术部位感染。主观 IKDC 评分和 KOOS 分别显著改善，从 53.6 提高至 80.7，从 60.4 提高至 83.2。术后平均差异松弛度为 1.4mm（KT 1000）和 1.6mm（GNRB®）。3 名职业运动员中有 2 名在 1 年后回到了相同水平的运动项目，在娱乐性运动员中，54%的人恢复了以前的运动活动。
在复杂的韧带重建翻修中，同种异体肌腱移植物是可靠的，可以在法国使用。
IV；回顾性队列研究。
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