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采用自体腘绳肌腱增强缝线固定技术重建前交叉韧带后,临床评分良好,无胫骨过度前移的证据,患者运动功能恢复率高,再损伤率低。

Good clinical scores, no evidence of excessive anterior tibial translation, a high return to sport rate and a low re-injury rate is observed following anterior cruciate ligament reconstruction using autologous hamstrings augmented with suture tape.

机构信息

The School of Human Sciences (Exercise and Sport Science, M408), The University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia.

HFRC Rehabilitation Clinic, 117 Stirling Highway, Nedlands, WA, 6009, Australia.

出版信息

Arch Orthop Trauma Surg. 2023 Aug;143(8):5207-5220. doi: 10.1007/s00402-023-04835-9. Epub 2023 Mar 15.

Abstract

INTRODUCTION

Augmented anterior cruciate ligament reconstruction (ACLR) techniques have been proposed to reduce the high reported re-injury rates and low rates of return to sport (RTS). This study reports clinical outcomes, RTS and re-injury rates in patients undergoing ACLR using autologous hamstrings augmented with suture tape.

MATERIALS AND METHODS

A total of 53 patients were prospectively recruited, undergoing ACLR using hamstrings with suture tape augmentation, combined with a structured rehabilitation programme. Outcomes were collected to 24 months, including patient-reported outcome measures (PROMs), KT-1000 measurements, peak isokinetic knee strength and a four hop test battery. Limb Symmetry Indices (LSIs) were calculated for performance measures, whilst RTS rates, re-tears and re-operations were presented.

RESULTS

There were no significant side-to-side differences in anterior tibial translation between the operated and non-operated knees at 6 months (p = 0.433), with no increase (p = 0.841) in side-to-side anterior tibial translation from 6 to 24 months. At 24 months, 98.0% of patients demonstrated normal (< 3 mm) or near normal (3-5 mm) side-to-side differences. LSIs for peak knee extensor torque (p < 0.0001) and the single (p = 0.001), triple (p = 0.001) and triple crossover (p < 0.0001) hop tests for distance significantly improved. All PROMs significantly improved (p < 0.0001), with 70.2% and 85.7% of patients actively participating in pivoting sports at 12 and 24 months, respectively. Three patients underwent secondary procedures for meniscal symptoms. One patient suffered an ACL re-tear (17 months), with no further ipsilateral or contralateral injuries.

CONCLUSION

ACLR with suture tape augmentation demonstrated no evidence of excessive anterior tibial translation, high-scoring PROMs, sound performance scores, a high rate of RTS and low re-injury rate.

摘要

简介

增强型前交叉韧带重建(ACLR)技术已被提出,以降低高报告的再受伤率和低重返运动(RTS)率。本研究报告了接受自体腘绳肌腱增强缝合带 ACLR 的患者的临床结果、RTS 和再受伤率。

材料和方法

共前瞻性招募了 53 名患者,接受了 ACLR 治疗,使用腘绳肌腱增强缝合带,并结合了结构化康复计划。结果收集至 24 个月,包括患者报告的结局测量(PROMs)、KT-1000 测量、峰值等速膝关节力量和四项跳跃测试电池。计算了性能测量的肢体对称指数(LSI),同时报告了 RTS 率、再撕裂和再手术。

结果

在 6 个月时,手术侧和非手术侧的胫骨前平移没有明显的侧到侧差异(p=0.433),从 6 个月到 24 个月,胫骨前平移没有增加(p=0.841)。在 24 个月时,98.0%的患者表现出正常(<3mm)或接近正常(3-5mm)的侧到侧差异。峰值膝关节伸肌扭矩的 LSI(p<0.0001)以及单(p=0.001)、三(p=0.001)和三重交叉(p<0.0001)跳跃测试的距离显著改善。所有 PROMs 均显著改善(p<0.0001),分别有 70.2%和 85.7%的患者在 12 个月和 24 个月时积极参与旋转运动。3 名患者因半月板症状接受了二次手术。1 名患者发生 ACL 再撕裂(17 个月),同侧或对侧无进一步损伤。

结论

使用缝合带增强的 ACLR 没有证据表明前胫骨过度平移、高评分的 PROMs、健全的表现评分、高 RTS 率和低再受伤率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc8d/10374472/27d70968f2c8/402_2023_4835_Fig1_HTML.jpg

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