University of British Columbia, New Westminster, Canada.
Canadian Institutes of Health Research, Ottawa, Ontario, Canada.
Am J Sports Med. 2022 Nov;50(13):3502-3509. doi: 10.1177/03635465221128581. Epub 2022 Oct 19.
Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter.
To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure.
Cohort study; Level of evidence, 2.
Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)-namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively.
Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors-namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; = .76). There was no significant difference between the groups in Lachman ( = .46) and pivot-shift ( = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL ( = .67) and IKDC ( = .83) scores between the 2 subgroups.
At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.
已证实直径<8mm 的前交叉韧带（ACL）重建（ACLR）具有更高的翻修率。5 股（5S）腘绳肌腱自体移植物构型是增加移植物直径的一种建议选择。
探讨 ACLR 中 4 股（4S）和 5S 腘绳肌腱自体移植物在单独进行 ACLR 或同时进行外侧关节外 tenodesis（LET）手术的患者中的临床结果差异。
队列研究；证据水平，2 级。
对 STABILITY 研究的数据进行分析，比较了最小移植物直径≥8mm 的单独进行 ACLR 或同时进行 LET 手术（ACLR + LET）的患者的一个亚组，这些患者采用 4S 或 5S 腘绳肌腱自体移植物构型。主要结局是旋转不稳定性和/或移植物失败的复合临床失败。次要结局指标包括 2 项患者报告的结局评分，即 ACL 生活质量问卷（ACL-QoL）和术后 24 个月的国际膝关节文献委员会（IKDC）评分。
在 STABILITY 研究中，618 名随机患者中，399 名（228 名男性；57%）符合本研究的纳入标准。其中，191 名和 208 名患者分别接受了 4S 和 5S 构型的腘绳肌腱 ACLR，最小移植物直径为 8mm。两组除了在人体测量因素方面存在差异，如性别、身高和体重以及 Beighton 评分外，其他特征均相似。主要结局显示，两组在旋转稳定性（比值比 [OR]，1.19；95%CI，0.77-1.84； =.42）或移植物失败（OR，1.13；95%CI，0.51-2.50； =.76）方面无差异。两组在术后 24 个月的 Lachman（ =.46）和 pivot-shift（ =.53）试验结果无显著差异。次要结局显示，在 ACL-QoL（ =.67）和 IKDC（ =.83）评分方面，两组之间无差异。
在分析 ACLR 或 ACLR + LET 中直径≥8mm 的 4S 和 5S 腘绳肌腱自体移植物的患者中，24 个月时的临床失败率和 PRO 无显著差异。5S 腘绳肌腱移植物构型是产生较大直径 ACL 移植物的可行选择。
