用于前交叉韧带重建的小腘绳肌腱移植物结合前外侧韧带重建与单独使用较大腘绳肌腱移植物重建的失败率相同。
Small Hamstring Tendon Graft for Anterior Cruciate Ligament Reconstruction Combined With Anterolateral Ligament Reconstruction Results in the Same Failure Rate as Larger Hamstring Tendon Graft Reconstruction Alone.
机构信息
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio Libanês, São Paulo, Brazil.
Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
出版信息
Arthroscopy. 2023 Jul;39(7):1671-1679. doi: 10.1016/j.arthro.2023.01.101. Epub 2023 Feb 10.
PURPOSE
To compare patients undergoing anterior cruciate ligament (ACL) reconstruction with hamstring grafts 7 mm or less in diameter combined with anterolateral ligament (ALL) reconstruction versus isolated ACL reconstruction with grafts greater than 7 mm in diameter.
METHODS
We retrospectively evaluated the descriptive data and clinical outcomes of patients who underwent primary ACL reconstruction with hamstring grafts from June 2013 to January 2020 and had a minimum follow-up period of 2 years. Patients with quadrupled or quintupled semitendinosus and gracilis autograft 7 mm or less in diameter combined with single-strand ALL reconstruction (ACL-ALL group) were matched in a 1:2 propensity ratio to patients who underwent isolated single-bundle ACL reconstruction with hamstring grafts greater than 7 mm (ACL group).
RESULTS
We identified 30 patients in our database who met the criteria for the ACL-ALL group. The patients in this group were matched to 60 patients comprising the ACL group. Both groups were similar regarding all preoperative matched and unmatched variables. The mean ACL graft diameter was 6.8 ± 0.4 mm in the ACL-ALL group and 8.6 ± 0.6 mm in the ACL group (P < .001). The ACL-ALL group presented 1 failure (3.3%), and the ACL group presented 3 failures (5%) (P = .717). Postoperative KT-1000 measurements were similar between the groups (2.1 ± 1.1 mm vs 1.9 ± 1.2 mm, P = .114), as were postoperative pivot-shift grades (P = .652). Subjective International Knee Documentation Committee scores and Lysholm scores did not present any differences between the groups (P = .058 and P = .280, respectively).
CONCLUSIONS
Patients who undergo combined ACL-ALL reconstruction with an ACL graft diameter of 7 mm or less can achieve similar results to patients who undergo isolated ACL reconstruction with a graft diameter greater than 7 mm. An associated ALL reconstruction can be performed to increase knee stability in patients with small-diameter hamstring grafts.
LEVEL OF EVIDENCE
Level III, retrospective, comparative therapeutic trial.
目的
比较 ACL 重建中使用直径 7mm 或更小的腘绳肌腱移植物联合前外侧韧带（ALL）重建与使用直径大于 7mm 的移植物进行单纯 ACL 重建的患者。
方法
我们回顾性评估了 2013 年 6 月至 2020 年 1 月期间接受 ACL 重建并采用腘绳肌腱移植物且随访时间至少 2 年的患者的描述性数据和临床结果。直径 7mm 或更小的四股或五股半腱肌和股薄肌自体移植物联合单束 ALL 重建患者（ACL-ALL 组）按照 1:2 的倾向比例与接受单纯腘绳肌腱移植物重建且直径大于 7mm 的 ACL 重建患者（ACL 组）进行匹配。
结果
我们在数据库中确定了符合 ACL-ALL 组标准的 30 名患者。该组患者与 ACL 组的 60 名患者相匹配。两组患者在所有术前匹配和不匹配的变量上均相似。ACL-ALL 组 ACL 移植物的平均直径为 6.8±0.4mm，ACL 组为 8.6±0.6mm（P<0.001）。ACL-ALL 组发生 1 例失败（3.3%），ACL 组发生 3 例失败（5%）（P=0.717）。两组术后 KT-1000 测量值相似（2.1±1.1mm 与 1.9±1.2mm，P=0.114），术后髌股关节偏移分级也相似（P=0.652）。两组患者的国际膝关节文献委员会主观评分和 Lysholm 评分无差异（P=0.058 和 P=0.280）。
结论
直径 7mm 或更小的 ACL-ALL 重建联合 ACL 移植物重建的患者可获得与直径大于 7mm 的 ACL 移植物重建患者相似的结果。对于小直径腘绳肌腱移植物患者，可进行联合 ALL 重建以增加膝关节稳定性。
证据水平
III 级，回顾性，对照治疗试验。
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