Sports Doctors, Christchurch, New Zealand.
Forte Sports, Christchurch, New Zealand.
Am J Sports Med. 2023 Mar;51(3):627-633. doi: 10.1177/03635465221146299. Epub 2023 Jan 19.
Young female athletes are a specific population that is at high risk of primary anterior cruciate ligament (ACL) rupture and subsequent graft failure. Despite large numbers of ACL reconstructions being carried out in young women, there is limited analysis of outcomes in this group, leading to low levels of evidence for graft choice.
To assess the effect of graft choice on ACL reconstruction failure rates among young women in New Zealand.
Cohort study; Level of evidence, 2.
Prospective data captured by the New Zealand ACL Registry between April 2014 and March 2022 were reviewed. Young women aged 15 to 20 years were included. The primary outcome measure was ACL graft failure during the study period, with the key independent variable being graft type, either patellar or hamstring tendon autograft. This is presented as the rate per 100 patient-years and is compared between the 2 groups using the hazard ratio generated from a Cox proportional hazards regression. Secondary outcome measures were Marx activity scores and the Knee injury and Osteoarthritis and Outcome Score patient-reported outcome measure.
A total of 1261 primary ACL reconstructions in young women aged 15 to 20 years were reviewed. Hamstring tendon grafts were used in 797 (63%) reconstructions and patellar tendon graft in 464 (37%) reconstructions. Patients with a hamstring tendon graft had a graft failure rate of 7.7% compared with 1.1% in patients with a patellar tendon graft (hazard ratio, 6.1; 95% CI, 2.4-15.1; < .001). The number of failures per 100 person-years was significantly higher in the hamstring group (2.05) compared with the patellar tendon group (0.37). No difference was noted at final follow-up between the hamstring tendon and patellar tendon groups when comparing patient-reported outcome measures during the follow-up period.
In the young female population of this study, the use of a patellar tendon graft was associated with reduced risk of graft failure and was not associated with an increase in knee morbidity. This highlights the importance of informed decision-making in this high-risk population when considering ACL reconstruction graft type.
年轻女性运动员是 ACL （前交叉韧带）初次破裂和随后移植物失败风险较高的特定人群。尽管在年轻女性中进行了大量的 ACL 重建，但对该组患者的结果进行的分析有限，导致移植物选择的证据水平较低。
评估新西兰年轻女性 ACL 重建失败率与移植物选择的关系。
队列研究；证据等级，2 级。
对 2014 年 4 月至 2022 年 3 月期间新西兰 ACL 注册中心前瞻性收集的数据进行了回顾。纳入年龄在 15 至 20 岁的年轻女性患者。主要观察指标是研究期间的 ACL 移植物失败率，关键的独立变量是移植物类型，髌腱或腘绳肌腱自体移植物。该结果以每 100 患者年的发生率表示，并通过 Cox 比例风险回归生成的风险比在 2 组间进行比较。次要观察指标是 Marx 活动评分和膝关节损伤和骨关节炎结果评分患者报告的结果测量。
共回顾了 1261 例 15 至 20 岁年轻女性的初次 ACL 重建。797 例（63%）重建采用腘绳肌腱移植物，464 例（37%）采用髌腱移植物。使用腘绳肌腱移植物的患者移植物失败率为 7.7%，而使用髌腱移植物的患者为 1.1%（风险比，6.1；95%CI，2.4-15.1；<0.001）。腘绳肌腱组每 100 人年的失败人数（2.05）明显高于髌腱组（0.37）。在最终随访时，当比较随访期间的患者报告结果测量值时，腘绳肌腱组和髌腱组之间没有差异。
在本研究的年轻女性人群中，使用髌腱移植物与降低移植物失败风险相关，与膝关节发病率增加无关。这凸显了在考虑 ACL 重建移植物类型时，在这个高风险人群中进行知情决策的重要性。
