Peng Y, Xu J C, Fu D J, Yang L, Guo L
Center for Joint Surgery, First Affiliated Hospital, Army Medical University, Chongqing 400038, China;2Sports Medicine Center, First Affiliated Hospital, Army Medical University, Chongqing 400038, China.
Sports Medicine Center, First Affiliated Hospital, Army Medical University, Chongqing 400038, China.
Zhonghua Yi Xue Za Zhi. 2023 Mar 21;103(11):822-828. doi: 10.3760/cma.j.cn112137-20220915-01957.
To compare the clinical efficacy of a new generation of ligaments (LARS artificial ligament) and bone-patellar tendon-bone (BPTB) autograft as grafts in anterior cruciate ligament (ACL) revision. A retrospective cohort study. The clinical data of 54 patients who underwent ACL revision from January 2018 to June 2020 in the First Hospital Affiliated to Army Medical University were retrospectively analyzed. There were 44 males and 10 females with a mean age of (28.5±7.7) years (15-45 years). Among them, 24 cases underwent ACL revision with LARS artificial ligament (LARS group), the other 30 cases underwent ACL revision with BPTB (BPTB group). The subjective and objective knee joint evaluation indexes were compared between the two groups to evaluate the clinical efficacy. The subjective evaluation indexes included Tegner score, Lysholm score and the International Knee Documentation Committee (IKDC) score. The objective evaluation indexes included the Lachman test, pivot-shift test, the anterior tibial translation (ATT) measurement at the weight-bearing position and the rate of patients returned to pre-injury sports. The follow-up period was (32.8±5.3) months (24-42 months). At the last follow-up, the IKDC score, Tegner score and Lysholm score in the two groups significantly increased when compared with those before surgery (all <0.05), and there was no significant difference in those indexes between the two groups (all >0.05). The ATT measurement in the weight-bearing position was (3.1±0.7) mm in the LARS group and it was (4.1±0.9) mm in the BPTB group, which were significantly improved when compared with those before surgery (both <0.05), and it was better in the LARS group than in the BPTB group (<0.05). Postoperative Lachman test and pivot-shift test results in the LARS group were better than those in the BPTB group with statistically significant difference (both <0.05). The rate of patients returned to pre-injury sports one year after surgery was 79.2%(19/24) in the LARS group and it was 50.0%(15/30) in the BPTB group, and the difference was statistically significant (=0.029). Both LARS artificial ligament and BPTB autograft can achieve good short-term clinical efficacy in ACL revision, but LARS artificial ligament group has more advantages than BPTB autograft group in knee stability and early return to sports.
比较新一代韧带（LARS人工韧带）与自体骨-髌腱-骨（BPTB）作为移植物在前交叉韧带（ACL）翻修术中的临床疗效。一项回顾性队列研究。回顾性分析2018年1月至2020年6月在陆军军医大学第一附属医院接受ACL翻修术的54例患者的临床资料。其中男性44例，女性10例，平均年龄（28.5±7.7）岁（15 - 45岁）。其中，24例采用LARS人工韧带进行ACL翻修术（LARS组），另外30例采用BPTB进行ACL翻修术（BPTB组）。比较两组患者膝关节主观和客观评估指标，以评价临床疗效。主观评估指标包括Tegner评分、Lysholm评分和国际膝关节文献委员会（IKDC）评分。客观评估指标包括Lachman试验、轴移试验、负重位胫骨前移（ATT）测量以及患者恢复伤前运动的比例。随访时间为（32.8±5.3）个月（24 - 42个月）。末次随访时，两组患者的IKDC评分、Tegner评分和Lysholm评分与术前相比均显著提高（均P<0.05），两组间这些指标差异均无统计学意义（均P>0.05）。LARS组负重位ATT测量值为（3.1±0.7）mm，BPTB组为（4.1±0.9）mm，与术前相比均显著改善（均P<0.05），且LARS组优于BPTB组（P<0.05）。术后LARS组的Lachman试验和轴移试验结果优于BPTB组，差异有统计学意义（均P<0.05）。术后1年LARS组患者恢复伤前运动的比例为79.2%（19/24），BPTB组为50.0%（15/30），差异有统计学意义（P = 0.029）。LARS人工韧带和BPTB自体移植物在前交叉韧带翻修术中均能取得良好的短期临床疗效，但LARS人工韧带组在膝关节稳定性和早期恢复运动方面比BPTB自体移植物组更具优势。
