Division of Sports Medicine, Department of Orthopaedics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
Am J Sports Med. 2023 Nov;51(13):3480-3492. doi: 10.1177/03635465231205304. Epub 2023 Oct 25.
An undersized hamstring tendon (HT) autograft is significantly associated with a higher graft failure rate in anterior cruciate ligament reconstruction (ACLR) surgery. The ability to accurately predict inadequate HT graft diameter is critical, as it could assist surgeons in making better graft choices and surgical plans.
To develop a web-based prediction tool to better assess the size of HT autograft and to help clinicians accurately identify patients with potentially undersized HT grafts in order to make appropriate clinical decisions.
Cross-sectional study; Level of evidence, 3.
A total of 588 patients who received primary arthroscopic single-bundle ACLR surgery with gracilis tendon (GT) and semitendinosus tendon (ST) autograft were retrospectively reviewed. According to the size of 4-strand HT graft, patients were divided into diameter ≥8 mm and <8 mm groups. The least absolute shrinkage and selection operator method and logistic regression were used to identify the independent factors associated with HT graft diameter and establish the models. The prediction performance of the model was evaluated by concordance index and calibration combined with external validation. The diagnostic performance of the prediction model was assessed by sensitivity, specificity, predictive values, and likelihood ratios. Decision curve analysis was used to evaluate the clinical utility of the model.
Among the numerous indicators, sex, weight, height, thigh length, and ST-GT diameter (measured on plane 1 of a magnetic resonance imaging scan) were identified to be highly correlated predictors that could provide satisfactory prediction performance in determining the HT graft diameter. Based on these predictors, a prediction model named the was developed with satisfactory discrimination (concordance index, 0.932) and calibration (mean absolute error, 0.039). When the probability calculated by the HTD model was >65%, the sensitivity and specificity of predicting 4-strand HT graft diameter ≥8 mm were 86.7% and 90.2%, respectively.
As a useful supplementary prediction tool, the HTD model could accurately predict the diameter of HT autograft during preoperative planning.
在前交叉韧带重建 (ACL) 手术中，尺寸过小的腘绳肌腱 (HT) 移植物与更高的移植物失败率显著相关。准确预测 HT 移植物直径不足的能力至关重要，因为它可以帮助外科医生做出更好的移植物选择和手术计划。
开发一个基于网络的预测工具，以更好地评估 HT 移植物的大小，并帮助临床医生准确识别可能存在 HT 移植物尺寸不足的患者，以便做出适当的临床决策。
横断面研究；证据水平，3 级。
回顾性分析了 588 例接受单纯关节镜下单束 ACLR 手术、使用股薄肌 (GT) 和半腱肌 (ST) 自体移植物的患者。根据 4 股 HT 移植物的直径，将患者分为直径≥8mm 和<8mm 两组。采用最小绝对收缩和选择算子法和逻辑回归法确定与 HT 移植物直径相关的独立因素，并建立模型。通过一致性指数和校准结合外部验证评估模型的预测性能。通过敏感性、特异性、预测值和似然比评估预测模型的诊断性能。决策曲线分析用于评估模型的临床实用性。
在众多指标中，性别、体重、身高、大腿长度和 ST-GT 直径（在磁共振成像扫描的平面 1 上测量）被确定为高度相关的预测因素，可以提供令人满意的预测性能，用于确定 HT 移植物直径。基于这些预测因素，开发了一种名为 HTD 模型的预测模型，具有令人满意的区分度（一致性指数为 0.932）和校准度（平均绝对误差为 0.039）。当 HTD 模型计算的概率>65%时，预测 4 股 HT 移植物直径≥8mm 的敏感性和特异性分别为 86.7%和 90.2%。
作为一种有用的辅助预测工具，HTD 模型可以在术前计划中准确预测 HT 自体移植物的直径。
