Cristiani Riccardo, Forssblad Magnus, Edman Gunnar, Eriksson Karl, Stålman Anders
Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden; Capio Artro Clinic, FIFA Medical Centre of Excellence, Sophiahemmet Hospital, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
Arthroscopy. 2024 Jun;40(6):1824-1832. doi: 10.1016/j.arthro.2023.10.029. Epub 2023 Oct 28.
To evaluate and compare isokinetic knee muscle (extension and flexion) strength, single-leg hop (SLH) test performance, anterior knee laxity, subjective knee function, and the 2-year revision surgery risk between patients who underwent anterior cruciate ligament reconstruction (ACLR) with semitendinosus tendon (ST) autografts and patients who underwent ACLR with ST and gracilis tendon (ST-G) autografts.
We identified patients aged 16 years or older who underwent primary ACLR with hamstring tendon autografts at our institution from January 2005 to December 2020 and had no associated ligament injuries. Isokinetic knee muscle strength and SLH test performance were assessed 6 months postoperatively. Anterior knee laxity (KT-1000 arthrometer, 134 N) was assessed preoperatively and 6 months postoperatively. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and 1 and 2 years postoperatively. Patients who underwent revision ACLR at any institution in Sweden within 2 years of primary surgery were identified through the Swedish National Knee Ligament Registry.
A total of 6,974 patients (5,479 with ST and 1,495 with ST-G) were included. There were no significant differences in extension and flexion strength or SLH test performance between the groups. Preoperatively, there was no significant difference in knee laxity between the ST and ST-G groups. Postoperatively, the ST-G group had significantly increased mean side-to-side (STS) laxity (2.1 ± 2.3 mm vs 1.7 ± 2.2 mm, P < .001) and showed a trend toward increased STS laxity according to the International Knee Documentation Committee form, with significantly fewer patients with STS laxity of 2 mm or less (58.4% vs 65.8%) and significantly more patients with STS laxity between 3 and 5 mm (35.0% vs 29.9%) or greater than 5 mm (6.6% vs 4.3%) (P < .001). The only significant difference in subjective knee function was for the KOOS Quality of Life subscale score in favor of the ST group preoperatively (37.3 ± 21.4 vs 35.1 ± 19.9, P = .001). No other significant differences between the groups were found preoperatively and 1 and 2 years postoperatively for any of the KOOS subscales. The overall revision ACLR rate within 2 years of primary surgery was 2.0% (138 of 6,974 patients). The revision ACLR risk in the ST-G group (1.7%, 25 of 1,495 patients) was not significantly different from that in the ST group (2.1%, 113 of 5,479 patients) (hazard ratio, 0.80; 95% confidence interval, 0.50-1.24; P = .32).
The addition of the gracilis tendon to an ST autograft was not associated with knee muscle strength, SLH test performance, subjective knee function, or the risk of revision surgery after ACLR.
Level III, retrospective comparative study.
评估并比较接受半腱肌（ST）自体移植进行前交叉韧带重建（ACLR）的患者与接受ST和股薄肌肌腱（ST-G）自体移植进行ACLR的患者之间的等速膝关节肌肉（伸展和屈曲）力量、单腿跳（SLH）测试表现、膝关节前向松弛度、主观膝关节功能以及2年翻修手术风险。
我们纳入了2005年1月至2020年12月期间在本机构接受初次自体腘绳肌腱ACLR且年龄在16岁及以上且无相关韧带损伤的患者。术后6个月评估等速膝关节肌肉力量和SLH测试表现。术前和术后6个月评估膝关节前向松弛度（KT-1000关节测量仪，134 N）。术前以及术后1年和2年收集膝关节损伤和骨关节炎结局评分（KOOS）。通过瑞典国家膝关节韧带登记处确定在初次手术2年内于瑞典任何机构接受ACLR翻修手术的患者。
共纳入6974例患者（5479例接受ST移植，1495例接受ST-G移植）。两组之间的伸展和屈曲力量或SLH测试表现无显著差异。术前，ST组和ST-G组之间的膝关节松弛度无显著差异。术后，ST-G组的平均左右（STS）松弛度显著增加（2.1±2.3 mm对1.7±2.2 mm，P<.001），并且根据国际膝关节文献委员会表格显示出STS松弛度增加的趋势，STS松弛度为2 mm或更小的患者显著减少（58.4%对65.8%），STS松弛度在3至5 mm之间（35.0%对29.9%）或大于5 mm（6.6%对4.3%）的患者显著增多（P<.001）。主观膝关节功能的唯一显著差异在于术前KOOS生活质量子量表评分有利于ST组（37.3±21.4对35.1±19.9，P=.001）。术前以及术后1年和2年，两组之间在任何KOOS子量表上均未发现其他显著差异。初次手术2年内的总体ACLR翻修率为2.0%（6974例患者中的138例）。ST-G组的ACLR翻修风险（1.7%，1495例患者中的25例）与ST组（2.1%，5479例患者中的113例）无显著差异（风险比，0.80；95%置信区间，0.50 - 1.24；P=.32）。
在ST自体移植中添加股薄肌肌腱与ACLR后的膝关节肌肉力量、SLH测试表现、主观膝关节功能或翻修手术风险无关。
III级，回顾性比较研究。
