保留半腱肌远端附着点与 ACL 重建后移植物重塑改善相关。
Preserving the Semitendinosus Distal Attachment Is Associated With Improved Graft Remodeling After ACL Reconstruction.
机构信息
Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France.
Orthopaedics Unit, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra.
出版信息
Am J Sports Med. 2023 Jul;51(8):2064-2072. doi: 10.1177/03635465231169047. Epub 2023 May 19.
BACKGROUND
The semitendinosus (ST) tendon can be used by itself as a graft for anterior cruciate ligament (ACL) reconstruction. An increasing number of these procedures are being done while preserving the ST's tibial attachment, but there are no data on the remodeling of an attached ST (aST) graft.
PURPOSE
To compare graft remodeling on magnetic resonance imaging (MRI) scans at 1 year after ACL reconstruction between standard free ST graft and aST graft.
STUDY DESIGN
Cohort study; Level of evidence, 3.
METHODS
This prospective study enrolled 180 patients who were undergoing ACL reconstruction: 90 with the ST graft and 90 with the aST graft. The analysis was performed 1 year after the surgery. The main endpoint was the signal-to-noise quotient (SNQ) on MRI scans (T1-weighted sequence). The secondary endpoints were tibial tunnel widening (TTW), graft maturation (Howell classification), retear rate, new surgery rate, Simple Knee Value, Lysholm score, International Knee Documentation Committee (IKDC) score, postoperative Tegner score, difference between pre- and postoperative Tegner scores, ACL-Return to Sport after Injury (ACL-RSI), return-to-sports rate, and time to return to sports.
RESULTS
The mean adjusted SNQ was 1.18 (95% CI, 0.72-1.65) in the aST group and 3.88 (95% CI, 3.42-4.34) in the ST group ( < .001). The new surgery rate was 2.2% in the aST group and 10% in the ST group ( = .029). The median Lysholm score was significantly higher in the aST group (99; interquartile range [IQR], 95-100) than in the ST group (95; IQR, 91-99) ( = .004). The mean time to return to sports was significantly shorter in the aST group (248.73 ± 141.62 days) than the ST group (317.23 ± 144.69 days) ( = .002). No statistically significant difference was found between groups in the TTW ( = .503), Howell graft maturity grade ( = .149), retear rate ( > .999), Simple Knee Value ( = .061), postoperative Tegner score ( = .320), pre- to postoperative difference in Tegner score ( = .317), ACL-RSI ( = .097), IKDC score ( = .621), and return-to-sports rate ( > .999).
CONCLUSION
At 1 year postoperatively, remodeling of an ST graft assessed using MRI is better when its distal attachment is left intact.
背景
半腱肌（ST）肌腱可单独用作前交叉韧带（ACL）重建的移植物。越来越多的此类手术在保留 ST 胫骨附着点的情况下进行，但关于附着 ST（aST）移植物的重塑尚无数据。
目的
比较 ACL 重建后 1 年 MRI 扫描中标准游离 ST 移植物和 aST 移植物的移植物重塑。
研究设计
队列研究；证据水平，3 级。
方法
这项前瞻性研究纳入了 180 例接受 ACL 重建的患者：90 例行 ST 移植物重建，90 例行 aST 移植物重建。术后 1 年进行分析。主要终点是 MRI 扫描（T1 加权序列）的信噪比（SNQ）。次要终点包括胫骨隧道增宽（TTW）、移植物成熟（Howell 分级）、再撕裂率、新手术率、简单膝关节评分、Lysholm 评分、国际膝关节文献委员会（IKDC）评分、术后 Tegner 评分、术前与术后 Tegner 评分差值、ACL 运动后损伤重返运动（ACL-RSI）评分、重返运动率和重返运动时间。
结果
aST 组的平均调整后 SNQ 为 1.18（95%CI，0.72-1.65），ST 组为 3.88（95%CI，3.42-4.34）（<0.001）。aST 组的新手术率为 2.2%，ST 组为 10%（=0.029）。aST 组的 Lysholm 评分中位数明显高于 ST 组（99；四分位距 [IQR]，95-100）（=0.004）。aST 组重返运动的平均时间明显短于 ST 组（248.73±141.62 天）（317.23±144.69 天）（=0.002）。两组间 TTW（=0.503）、Howell 移植物成熟分级（=0.149）、再撕裂率（>0.999）、简单膝关节评分（=0.061）、术后 Tegner 评分（=0.320）、术前与术后 Tegner 评分差值（=0.317）、ACL-RSI（=0.097）、IKDC 评分（=0.621）和重返运动率（>0.999）无统计学差异。
结论
术后 1 年，当 ST 移植物的远端附着保持完整时，使用 MRI 评估其重塑效果更好。
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