使用四头肌腱、腘绳肌腱和髌腱自体移植物进行 ACL 翻修重建可获得相似的功能结果，但腘绳肌腱移植物更倾向于发生移植物失败。
Revision ACL reconstruction using quadriceps, hamstring and patellar tendon autografts leads to similar functional outcomes but hamstring graft has a higher tendency of graft failure.
机构信息
Gelenkpunkt-Sports and Joint Surgery, FIFA Medical Centre of Excellence, Olympiastraße 39, 6020, Innsbruck, Austria.
Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Medical Informatics and Technology, Private University for Health Sciences, Innsbruck, Austria.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2023 Jun;31(6):2461-2468. doi: 10.1007/s00167-022-07200-2. Epub 2022 Oct 20.
PURPOSE
The purpose of this study was to evaluate the differences in the patient-reported functional outcomes, and graft failure in revision ACL reconstruction using quadriceps tendon (QT), Hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts.
METHODS
Between 2010 and 2020, 97 patients who underwent revision ACL reconstruction (40 patients received a QT, 26 an HT and 31 a BPTB graft) met the inclusion criteria. Pre-injury and at 2-year postoperatively patients were evaluated for patient-reported functional outcomes; Lysholm knee score, Tegner activity level and VAS (visual analogue scale) for pain; and graft failure. Patient-reported outcomes and graft failure were compared between the QT, HT and BPTB groups. The patients with graft failure were not included for outcome analysis at 2-years of follow-up.
RESULTS
All three revision groups with QT, HT and BPTB autograft did not differ significantly in terms of age, sex, time from injury to surgery, concomitant injuries and single-stage or double-stage procedures (n.s.). No significant difference was found in the pre-injury patient-reported outcome; Lysholm knee score, Tegner activity and VAS for pain (n.s.) between the three groups. At the 2-year follow-up functional outcomes improved in all three groups and all the patients returned to pre-injury activity level; however, no significant difference was found in functional outcomes at the 2-year follow-up between the three groups (n.s.). Graft failure occurred in 4 (10%), 5 (19%) and 3 (10%) patients of QT, HT and BPTB groups, respectively. However, the rate of failure did not differ significantly between groups.
CONCLUSION
All three autografts (QT, HT and BPTB) demonstrated satisfactory patient-reported outcomes in revision ACL reconstruction. Compared with QT and BPTB grafts, HT graft showed a higher tendency for failure rates. With the increasing incidence of revision ACL reconstruction, surgeons should be aware of all the available graft options. The findings of this study will assist the surgeons in the graft selection for revision ACL reconstruction.
LEVEL OF EVIDENCE
Level III.
目的
本研究旨在评估在接受前交叉韧带（ACL）重建的翻修手术中，使用股四头肌腱（QT）、腘绳肌腱（HT）和骨-髌腱-骨（BPTB）自体移植物在患者报告的功能结果和移植物失败方面的差异。
方法
在 2010 年至 2020 年期间，97 名接受 ACL 重建翻修手术的患者（40 名患者接受 QT 移植物，26 名患者接受 HT 移植物，31 名患者接受 BPTB 移植物）符合纳入标准。在术前和术后 2 年，对患者进行患者报告的功能结果评估；包括 Lysholm 膝关节评分、Tegner 活动水平和疼痛的视觉模拟评分（VAS）；以及移植物失败情况。比较 QT、HT 和 BPTB 组之间的患者报告结果和移植物失败情况。在术后 2 年的随访中，将发生移植物失败的患者排除在结果分析之外。
结果
接受 QT、HT 和 BPTB 自体移植物的三组翻修患者在年龄、性别、受伤至手术的时间、合并伤和单阶段或双阶段手术方面无显著差异（无统计学意义）。三组患者在术前患者报告的结果（Lysholm 膝关节评分、Tegner 活动和疼痛的 VAS）方面无显著差异（无统计学意义）。在术后 2 年的随访中，三组患者的功能结果均有所改善，所有患者均恢复到术前活动水平；然而，三组患者在术后 2 年的功能结果方面无显著差异（无统计学意义）。QT、HT 和 BPTB 组分别有 4（10%）、5（19%）和 3（10%）名患者发生移植物失败。然而，各组之间的失败率没有显著差异。
结论
在 ACL 重建的翻修手术中，所有三种自体移植物（QT、HT 和 BPTB）均表现出令人满意的患者报告结果。与 QT 和 BPTB 移植物相比，HT 移植物的失败率更高。随着 ACL 重建翻修手术的发生率不断增加，外科医生应该了解所有可用的移植物选择。本研究的结果将有助于外科医生选择 ACL 重建的移植物。
证据水平
III 级。
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