Department of Orthopaedics, School of Medicine, Emory University, Atlanta, Georgia, U.S.A..
Carolinas Medical Center, Charlotte, North Carolina, U.S.A.
Arthroscopy. 2021 Sep;37(9):2848-2857. doi: 10.1016/j.arthro.2021.03.035. Epub 2021 Mar 24.
The purposes were to (1) examine early to intermediate-term clinical outcomes and complications of revision anterior cruciate ligament reconstruction (ACLR) using all-soft tissue quadriceps tendon (QT) autografts, and (2) compare quadriceps strength between patients who had hamstring versus patella tendon autografts in their previous reconstruction.
One hundred patients (52 males/48 females; 22.6 ± 8.0 years) undergoing revision ACLR with all-soft tissue QT autografts were prospectively followed. All revision procedures were performed by a single surgeon, using a minimally invasive graft harvest technique and suspensory fixation. Subjective assessment of knee function was obtained before and after surgery with the International Knee Documentation Committee (IKDC) survey. Postoperative knee laxity and isokinetic quadriceps strength were collected at regular intervals. Strength was reported as limb symmetry index (LSI; surgical side divided by nonsurgical side). Complications including hematomas, postoperative loss of knee extension, and graft failures were recorded. To determine clinical significance (P ≤ .05), outcomes were compared using analysis of variance or paired samples t-tests.
The mean IKDC scores significantly improved (54.3 ± 13.0 vs 82.8 ± 13.8), with an average follow-up of 42.2 ± 21.2 months. There were no significant changes in knee laxity side-to-side differences: 6 weeks (1.2 ± 1.5 mm), 3 months (1.2 ± 1.8 mm), 6 months (1.4 ± 1.6 mm). Quadriceps LSIs significantly improved from 71.6% ± 19.3% at 6 months to 81.5% ± 19.3% at 12 months for 60°/s isokinetic testing and 76.6% ± 16.4% at 6 months to 83.9% ± 16.9% at 12 months for 180°/s testing. Graft harvest site hematomas developed in 2 patients, postoperative loss of knee extension in 4 patients, and graft failure in 11 patients. No significant differences in quadriceps or hamstrings LSIs were noted between patients with previous hamstring versus patella tendon autografts (P > .050).
Revision ACLR with all-soft tissue QT autografts has acceptable early and intermediate-term outcomes with reasonable complication rates (11/80 patients with follow-up). Secondary insult to the extensor mechanism via QT autograft harvest does not adversely affect strength after prior patellar tendon versus hamstring autograft.
Level IV, cases series subgroup analysis.
（1）检查使用全组织股四头肌肌腱（QT）自体移植物进行前交叉韧带重建（ACLR）翻修的早期至中期临床结果和并发症；（2）比较既往接受腘绳肌腱和髌腱自体移植物重建的患者的股四头肌力量。
前瞻性随访 100 例（52 名男性/48 名女性；22.6 ± 8.0 岁）接受全组织 QT 自体移植物进行 ACLR 翻修的患者。所有翻修手术均由一位经验丰富的外科医生进行，采用微创移植物采集技术和悬吊固定。使用国际膝关节文献委员会（IKDC）调查在术前和术后分别对膝关节功能进行主观评估。定期收集术后膝关节松弛度和等速股四头肌力量。力量以肢体对称性指数（LSI；手术侧除以非手术侧）报告。记录包括血肿、术后膝关节伸直丧失和移植物失败在内的并发症。为了确定临床意义（P ≤.05），使用方差分析或配对样本 t 检验比较结果。
平均 IKDC 评分显著提高（54.3 ± 13.0 比 82.8 ± 13.8），平均随访时间为 42.2 ± 21.2 个月。膝关节松弛度的侧间差异无显著变化：6 周（1.2 ± 1.5 mm）、3 个月（1.2 ± 1.8 mm）、6 个月（1.4 ± 1.6 mm）。60°/s 等速测试的股四头肌 LSI 从 6 个月时的 71.6%±19.3%显著提高至 12 个月时的 81.5%±19.3%，180°/s 测试的股四头肌 LSI 从 6 个月时的 76.6%±16.4%提高至 12 个月时的 83.9%±16.9%。2 例患者出现移植物采集部位血肿，4 例患者出现术后膝关节伸直丧失，11 例患者发生移植物失败。既往接受腘绳肌腱与髌腱自体移植物的患者之间，股四头肌或腘绳肌 LSI 无显著差异（P>.050）。
使用全组织 QT 自体移植物进行 ACLR 翻修具有可接受的早期和中期结果，并发症发生率合理（80 例患者中有 11 例随访）。通过 QT 自体移植物采集对伸肌机制的二次损伤不会对既往接受髌腱与腘绳肌腱自体移植物重建的患者的力量产生不利影响。
IV 级，病例系列亚组分析。
