Arida Christina, Tsikrikas Chrisovalantis G, Mastrokalos Dimitrios S, Panagopoulos Andreas, Vlamis John, Triantafyllopoulos Ioannis K
Orthopaedic Department, KAT Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, GRC.
Department of Knee Rehabilitation, Bioanataxi Physical Therapy Center, Athens, GRC.
Cureus. 2021 Nov 2;13(11):e19197. doi: 10.7759/cureus.19197. eCollection 2021 Nov.
Introduction To date, the proper choice of graft for anterior cruciate ligament (ACL) reconstruction remains a matter of conflict. We aimed to compare the clinical and functional outcomes of the two most commonly utilized autografts, bone-patella tendon-bone (BPTB) and four-strand hamstring tendon (HT) graft, at 6 and 12 months after surgery. Methods In a prospective randomized study, we included a total of 60 patients undergoing ACL reconstruction, thirty in BPTB and thirty in HT group. All patients were amateur athletes and were evaluated at 6 and12 months after surgery for: (a)postoperativefunctionality of the operated knee by the Tegner, the Lysholm and the International Knee Documentation Committee (IKDC) scoring scales, (b) anterior cruciate ligament (ACL) instability of the operated knee compared to the healthy contralateral knee by the KT-1000 arthrometer and (c) theextension and flexion muscle strength of the operated knee by a CYBEXisokinetic dynamometer. Results Patients in the two groups did not differ regarding demographics, and pre-injury functionality status. Significantly more patients in the HT group (n=6) compared to the BPTB group (n=1) experienced ACL re-rupture and underwent revision surgery before follow-up end (p=0.044). All patients, regardless of graft, showed significant improvement within each group of functional assessments by Lysholm, Tegner and IKDC scores, as well as of Cybex measurements -with an increase of peak torque at 60° extension and 180°extension and 60° flexion and 180° flexion- at 12 months compared to 6 months follow-up (p<0.05). However, there was no difference between the two groups regarding knee function improvement or extension measurements neither at 6 nor 12 months. Contrarily, the BPTB graft group had higher values of peak torque (Nm) at 60° and 180° flexion compared to the HT group, both at 6 (p=0.014 and 0.029, respectively) and 12 months (p=0.033 and 0.030, respectively). Postoperative stability was similar between the two groups at 12 months (p=0.519). Conclusion Both BPTB and HT grafts present with benefits and drawbacks and remain viable autograft options for primary ACL reconstruction as each has, although HT grafts seem to be more susceptible to re-rupture. The graft selection should be based on the needs and activities of each patient.
引言 迄今为止，前交叉韧带（ACL）重建中移植物的正确选择仍然存在争议。我们旨在比较两种最常用的自体移植物——骨-髌腱-骨（BPTB）和四股绳肌腱（HT）移植物在术后6个月和12个月时的临床和功能结果。方法 在一项前瞻性随机研究中，我们共纳入了60例行ACL重建的患者，30例采用BPTB移植物，30例采用HT移植物。所有患者均为业余运动员，并在术后6个月和12个月时进行评估：（a）通过Tegner、Lysholm和国际膝关节文献委员会（IKDC）评分量表评估患侧膝关节的术后功能；（b）通过KT-1000关节测量仪将患侧膝关节与健康对侧膝关节进行比较，评估前交叉韧带（ACL）的稳定性；（c）通过CYBEX等速测力计评估患侧膝关节的屈伸肌肉力量。结果 两组患者在人口统计学和伤前功能状态方面无差异。与BPTB组（n=1）相比，HT组（n=6）有更多患者在随访结束前发生ACL再次断裂并接受了翻修手术（p=0.044）。所有患者，无论采用何种移植物，在Lysholm、Tegner和IKDC评分以及Cybex测量的每组功能评估中均显示出显著改善——与6个月随访相比，12个月时60°伸展、180°伸展、60°屈曲和180°屈曲时的峰值扭矩增加（p<0.05）。然而，两组在6个月和12个月时膝关节功能改善或伸展测量方面均无差异。相反，在6个月（分别为p=0.014和0.029）和12个月（分别为p=0.033和0.030）时，BPTB移植物组在60°和180°屈曲时的峰值扭矩（Nm）值均高于HT组。两组在12个月时的术后稳定性相似（p=0.519）。结论 BPTB和HT移植物都有其优缺点，仍然是初次ACL重建可行的自体移植物选择，尽管HT移植物似乎更容易再次断裂。移植物的选择应基于每个患者的需求和活动情况。
