前交叉韧带重建术后股四头肌和腘绳肌腱自体移植的膝关节力量缺陷有所不同。
Knee strength deficits following anterior cruciate ligament reconstruction differ between quadriceps and hamstring tendon autografts.
作者信息
Johnston Peta T, Feller Julian A, McClelland Jodie A, Webster Kate E
机构信息
School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.
OrthoSport Victoria Research Unit, Melbourne, Australia.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2022 Apr;30(4):1300-1310. doi: 10.1007/s00167-021-06565-0. Epub 2021 Apr 19.
PURPOSE
To compare patient reported outcomes and functional knee recovery following anterior cruciate ligament (ACL) reconstruction using either a quadriceps tendon (QT) or hamstring tendon (HT) autograft.
METHODS
Thirty-five QT patients (age 20; range 15-34 years) participated in this study and were matched for gender, age and pre-injury activity level to 70 HT (age 20; range 15-32 years) patients. The following assessments were performed at 6 and 12 months post-operatively; standardized patient-reported outcome measures (IKDC, KOOS-QOL, ACL-RSI, Marx activity, anterior knee pain), knee range of motion (passive and active), anterior knee laxity, hop tests (single and triple crossover hop for distance), and isokinetic strength of the knee extensors and flexors. All dependent variables were analysed using a two-way mixed ANOVA model, with within (Time; 6 and 12 months) and between-subject (Graft; QT and HT) factors.
RESULTS
Patient reported outcome measures and hop performance improved between 6 and 12 months (p < 0.001), however no significant differences in either patient-reported outcomes or hop performance were found between the two grafts. Isokinetic strength testing showed both groups improved their peak knee extensor strength in the operated limb between 6 and 12 months (p < 0.001), but the QT group had significantly lower knee extensor strength symmetry at both time points compared to HT at 60 deg/s (p < 0.001) and 180 deg/s (p < 0.01). In contrast, the QT group had significantly greater knee flexor strength symmetry at both time points compared to HT at 60 deg/s (p < 0.01) and 180 deg/s (p = 0.01), but knee flexor strength limb symmetry did not significantly improve over time in either group.
CONCLUSION
Recovery of knee function following either QT or HT ACL reconstruction continues between 6 and 12 months after surgery. However, knee extensor strength deficits in the QT group and knee flexor strength deficits in the HT persisted at 12 months. This may have implications for decisions regarding return to sport.
LEVEL OF EVIDENCE
III.
目的
比较使用股四头肌腱（QT）或腘绳肌腱（HT）自体移植进行前交叉韧带（ACL）重建后患者报告的结果和膝关节功能恢复情况。
方法
35例QT患者（年龄20岁；范围15 - 34岁）参与本研究，并在性别、年龄和伤前活动水平上与70例HT患者（年龄20岁；范围15 - 32岁）进行匹配。在术后6个月和12个月进行以下评估：标准化的患者报告结局指标（IKDC、KOOS - QOL、ACL - RSI、马克思活动度、前膝疼痛）、膝关节活动范围（被动和主动）、前膝松弛度、跳跃测试（单腿和双腿交叉跳跃距离）以及膝关节伸肌和屈肌的等速肌力。所有因变量均使用双向混合方差分析模型进行分析，该模型包含组内因素（时间；6个月和12个月）和组间因素（移植物；QT和HT）。
结果
患者报告的结局指标和跳跃表现在6个月至12个月之间有所改善（p < 0.001），然而，两种移植物在患者报告的结局或跳跃表现方面均未发现显著差异。等速肌力测试显示，两组在术后6个月至12个月之间患侧膝关节伸肌峰值力量均有所提高（p < 0.001），但在60°/秒（p < 0.001）和180°/秒（p < 0.01）时，QT组在两个时间点的膝关节伸肌力量对称性均显著低于HT组。相比之下，在60°/秒（p < 0.01）和180°/秒（p = 0.01）时，QT组在两个时间点的膝关节屈肌力量对称性均显著高于HT组，但两组的膝关节屈肌力量肢体对称性均未随时间显著改善。
结论
QT或HT ACL重建术后膝关节功能在术后6个月至12个月之间持续恢复。然而，QT组的膝关节伸肌力量缺陷和HT组的膝关节屈肌力量缺陷在12个月时仍然存在。这可能对恢复运动的决策产生影响。
证据水平
III级。
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