El-Azab Hossam, Moursy Mohamed, Mohamed Mohamed A, Elsayed Moustafa
Department of Orthopaedics and Traumatology, Sohag Faculty of Medicine, Sohag University, Egypt.
Department of Orthopedics and Traumatology, Paracelsus Medical University, Salzburg, Austria.
Injury. 2023 Mar;54(3):976-982. doi: 10.1016/j.injury.2023.01.033. Epub 2023 Jan 20.
Many patients who have had anterior cruciate ligament (ACL) reconstruction (R) complain of instability, inability to return to previous levels of sports activity, and possible ACL graft failure. Graft size was discovered to be an important factor in lowering ACL failure rates. Also, extraarticular tenodesis decreases recurrent instability, A comparative study was done to compare the effect of graft size and lateral external tenodesis on the recurrence of instability after ACL-R.
A Prospective Blinded Randomized Controlled study included 100 consecutive patients who underwent ACL-R with hamstring tendon grafts in our Hospital. The patients were allocated into two groups (Group A and B) with randomization; group A received ACL-R with a large-size ACL-graft diameter of 6 strands, and group B received ACL-R of 4 strands combined with lateral extraarticular tenodesis (LET) (Modified Lemaire). Each group had fifty patients. The follow-up time was two years. They were examined for graft failure, anterolateral rotatory instability with the pivot shift test, and clinical outcomes, which were evaluated with the International Knee Documentation Committee score (IKDC) both subjective and objective.
In this study; group A, graft failure occurred in three (6.3%) patients, a positive pivot shift test grade I was detected in eight (17.8%) patients, grade II in three (6.7%) patients, and grade III in one (2.2%) patient. The subjective IKDC score was 87.9 (± 7.19) points. The objective IKDC score was normal or nearly normal in 43 (93.4%) patients. In group B, one (2.1%) patient had graft failure, five (10.9%) had a positive pivot shift test grade I, one (2.1%) had a grade II, and no patient had a grade III. The subjective IKDC score was 91.9 (± 8.9) points. The objective IKDC score was normal or nearly normal in 44 (95.6%) patients. As regard the subjective IKDC score, there was a non-significant difference between both groups (p value = 0.465).
Both groups showed a low ACL-graft failure rate, low anterolateral rotatory instability, and a good clinical outcome. Although there was no significant difference in subjective IKDC score between both groups, the failure rate and anterolateral rotatory instability were significantly lower in the ACL-R (4 strands) with LET combination group than in the group with the large-diameter (6 strands) graft.
Level 1; Randomized Comparative Study.
许多接受前交叉韧带（ACL）重建术（R）的患者抱怨存在关节不稳定、无法恢复到先前的运动水平以及可能出现的ACL移植物失败。研究发现移植物大小是降低ACL失败率的一个重要因素。此外，关节外腱固定术可减少复发性不稳定。本研究进行了一项比较性研究，以比较移植物大小和外侧关节外腱固定术对ACL-R术后不稳定复发的影响。
一项前瞻性盲法随机对照研究纳入了我院100例连续接受腘绳肌腱移植物ACL-R的患者。患者随机分为两组（A组和B组）；A组接受直径为6股的大尺寸ACL移植物的ACL-R，B组接受4股的ACL-R联合外侧关节外腱固定术（LET）（改良Lemaire法）。每组各有50例患者。随访时间为两年。对患者进行移植物失败、通过轴移试验评估的前外侧旋转不稳定以及临床结果的检查，临床结果采用国际膝关节文献委员会评分（IKDC）进行主观和客观评估。
在本研究中；A组，3例（6.3%）患者发生移植物失败，8例（17.8%）患者检测到轴移试验I级阳性，3例（6.7%）患者为II级，1例（2.2%）患者为III级。主观IKDC评分为87.9（±7.19）分。43例（93.4%）患者的客观IKDC评分正常或接近正常。B组，1例（2.1%）患者发生移植物失败，5例（10.9%）患者轴移试验I级阳性，1例（2.1%）患者为II级，无患者为III级。主观IKDC评分为91.9（±8.9）分。44例（95.6%）患者的客观IKDC评分正常或接近正常。关于主观IKDC评分，两组之间无显著差异（p值 = 0.465）。
两组均显示出较低的ACL移植物失败率、较低的前外侧旋转不稳定以及良好的临床结果。虽然两组之间主观IKDC评分无显著差异，但LET联合的ACL-R（4股）组的失败率和前外侧旋转不稳定明显低于大直径（6股）移植物组。
1级；随机对照研究。
