Mohan Rahul, Kwaees Tariq Adam, Thomas Terin, Pydisetty Ravi
Mersey and West Lancashire Teaching Hospitals NHS Trust, Whiston Hospital, Prescot, L35 5DR, United Kingdom.
J Orthop. 2023 Jul 29;43:115-120. doi: 10.1016/j.jor.2023.07.030. eCollection 2023 Sep.
The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with implantable devices (internal brace reinforcement) is a technique purported to reduce the risk of rupture and hasten recovery. Few studies have examined these techniques, in particular when compared to non-augmented grafts. This study assesses the short-term outcome of ACL-R using augmented and non-augmented hamstring tendon autografts.
This was a retrospective cohort study comparing augmented and non-augmented ACL-R. All procedures were performed in a single centre using the same technique. The Knee injury and Osteoarthritis Outcome Score [KOOS] was used to assess patient-reported outcomes.
There were 70 patients in the augmented and 111 patients in the control group. Mean graft diameter in the augmented group was 8.82 mm versus 8.44 mm in the non-augmented. Six strand graft was achievable in 73.5% of the augmented group compared to 33% in the non-augmented group. Two graft failures were reported in the non-augmented group and none in the augmented group. Patient satisfaction rates were higher in the augmented group. There was a statistically insignificant improvement in the postoperative KOOS in the augmented group compared to the non-augmented group (p 0.6). Irrespective of augmentation status, no correlation was found between the functional score and age, or femoral tunnel width.
No statistically significant difference was demonstrated in the short-term functional outcome of ACL reconstruction using an augmented or non-augmented hamstring graft. Augmented ACL-R may achieve superior graft diameters, failure rates and patient reported outcomes when compared to nonaugmented ACL-R. Prospective trials are needed to examine this further.
前交叉韧带损伤的金标准治疗方法是重建术（ACL-R）。移植物失败是令人担忧的问题，确保初始移植物持久且能快速整合至关重要。使用可植入装置进行移植物增强（内部支撑加强）是一种旨在降低破裂风险并加速恢复的技术。很少有研究对这些技术进行检验，特别是与未增强的移植物相比时。本研究评估使用增强和未增强的腘绳肌腱自体移植物进行ACL-R的短期结果。
这是一项比较增强和未增强ACL-R的回顾性队列研究。所有手术均在单一中心采用相同技术进行。使用膝关节损伤和骨关节炎结局评分[KOOS]来评估患者报告的结果。
增强组有70例患者，对照组有111例患者。增强组的平均移植物直径为8.82毫米，未增强组为8.44毫米。增强组73.5%的患者可实现六股移植物，未增强组为33%。未增强组报告有2例移植物失败，增强组无失败病例。增强组患者满意度更高。与未增强组相比，增强组术后KOOS有统计学上无显著意义的改善（p 0.6）。无论是否增强，功能评分与年龄或股骨隧道宽度之间均未发现相关性。
使用增强或未增强的腘绳肌腱移植物进行ACL重建的短期功能结果无统计学显著差异。与未增强的ACL-R相比，增强的ACL-R可能在移植物直径、失败率和患者报告的结果方面更优。需要进一步进行前瞻性试验来研究这一点。
