Department of Trauma, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Orthopaedic Surgery, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
Arch Orthop Trauma Surg. 2022 Feb;142(2):281-289. doi: 10.1007/s00402-021-03862-8. Epub 2021 Mar 19.
Comparable data of functional outcomes of anterior cruciate ligament reconstruction using either hamstring- or quadriceps tendon grafts is controversial. This prospective, randomized controlled trial aims to provide data comparing both grafts regarding the functional outcome.
A two centre trial involving symptomatic patients 18 years of age or older with an anterior cruciate ligament tear was conducted. We randomly assigned 27 patients to quadruple hamstring tendon reconstruction and 24 to quadriceps tendon reconstruction. The patients were evaluated preoperatively, at 3, 6, 12 and 24 months post-surgery. The primary outcome parameter was the side-to-side knee laxity measured with an arthrometer. Secondary outcomes included results in the International Knee Documentation Committee (IKDC) and Lysholm Scores and isokinetic testing of strength in knee extension and flexion.
Forty-four patients (86%) completed the 2-year follow-up. There was significantly improved knee stability at all time intervals with no difference between the two study groups. The manual side-to-side displacement improved by 4.7 ± 3.0 mm in patients with hamstring tendon reconstruction and 5.5 ± 2.9 mm in patients with quadriceps tendon reconstruction. In addition, muscle strength and outcome scores (IKDC and Lysholm Score) did not show any differences between the hamstring tendon group and the quadriceps tendon group. Patients in the hamstring tendon group returned to their pre-injury activity level after 95.2 ± 45.5 days while patients in the quadriceps tendon group needed 82.1 ± 45.6 days.
Quadriceps and hamstring tendon autografts yield comparably good results in primary anterior cruciate ligament reconstruction.
使用腘绳肌腱或股四头肌腱重建前交叉韧带的功能结果的可比数据存在争议。本前瞻性、随机对照试验旨在提供比较两种移植物功能结果的数据。
一项涉及有前交叉韧带撕裂症状的 18 岁或以上的患者的双中心试验。我们将 27 例患者随机分配到四股腘绳肌腱重建组，24 例患者分配到股四头肌腱重建组。患者在术前、术后 3、6、12 和 24 个月进行评估。主要观察指标为关节测量仪测量的膝关节侧方松弛度。次要结局包括国际膝关节文献委员会（IKDC）和 Lysholm 评分的结果以及膝关节伸屈等速测试的力量。
44 例患者（86%）完成了 2 年随访。所有时间间隔的膝关节稳定性均显著改善，但两组之间无差异。采用腘绳肌腱重建的患者膝关节侧方位移改善了 4.7±3.0mm，采用股四头肌腱重建的患者膝关节侧方位移改善了 5.5±2.9mm。此外，肌肉力量和结局评分（IKDC 和 Lysholm 评分）在腘绳肌腱组和股四头肌腱组之间没有差异。腘绳肌腱组的患者在 95.2±45.5 天后恢复到受伤前的活动水平，而股四头肌腱组的患者则需要 82.1±45.6 天。
股四头肌腱和腘绳肌腱自体移植物在前交叉韧带重建中均能取得良好的效果。
