Orthopaedic Department, Sørlandet Hospital Arendal, Arendal, Norway.
Orthopaedic Surgery Clinic, Oslo University Hospital Ullevål, Oslo, Norway.
Knee Surg Sports Traumatol Arthrosc. 2024 Mar;32(3):656-665. doi: 10.1002/ksa.12081. Epub 2024 Feb 20.
Bone patella-tendon bone (BPTB) and hamstring tendon (HT) autografts are the most used grafts in primary anterior cruciate ligament (ACL) reconstructions (ACLR) in Norway. Quadriceps tendon (QT) autograft has gained more popularity during the past years. The purpose of this study is to compare revision rates and patient-reported outcomes of primary QT with BPTB and HT autograft ACL reconstructions in Norway at 2-year follow-up. It was hypothesized that there would be no difference in 2-year revision rates between all three autografts.
Data included primary ACLR without concomitant ligament surgeries, registered in the Norwegian Knee Ligament Register from 2004 through 2021. Revision rates at 2 years were calculated using Kaplan-Meier analysis. Hazard ratios (HR) for revision were estimated using multivariable Cox regression analysis with revision within 2 years as endpoint. Mean change in patient-reported outcome was recorded preoperatively and at 2 years through the Knee Injury and Osteoarthritis Outcome Score (KOOS) subcategories 'Sport' and 'Quality of Life' was measured for patients that were not revised and analysed with multiple linear regression.
A total of 24,790 primary ACLRs were identified, 10,924 with BPTB, 13,263 with HT and 603 with a QT graft. Patients in the QT group were younger (23.5 years), more of them were women (58.2%) and over 50% had surgery <3 months after injury. The QT group had the highest prevalence of meniscal injuries (61.9%). Revision estimates at 2-years were 3.6%, 2.5% and 1.2% for QT, HT and BPTB, respectively (p < 0.001). In a Cox regression analysis with QT as reference, BPTB had a lower risk of revision (HR 0.4, 95% Cl 0.2-0.7, p < 0.001). No significant difference was observed in the revision risk between QT and HT (HR 1.1, 95% Cl 0.7-1.8, n.s.). The two most common reported reasons for revision were: traumatic graft rupture and nontraumatic graft failure. There were no differences between the groups in change of KOOS in subcategories 'Sport' and 'Quality of Life' at 2-years follow-up.
The 2-year risk of revision after ACLR with QT was higher than BPTB and similar to HT. No difference was found between the groups in patient-reported outcomes. This study provides valuable insights for both surgeons and patients when making decisions about the choice of autografts in primary ACL reconstructions.
Level II.
在挪威，骨髌腱-骨（BPTB）和腘绳肌腱（HT）自体移植物是初次前交叉韧带（ACL）重建（ACLR）中最常使用的移植物。股四头肌肌腱（QT）自体移植物在过去几年中越来越受欢迎。本研究旨在比较挪威初次 QT 与 BPTB 和 HT 自体 ACLR 的翻修率和患者报告的结果，随访时间为 2 年。假设所有三种自体移植物在 2 年的翻修率上没有差异。
数据包括 2004 年至 2021 年期间在挪威膝关节韧带登记处注册的无伴发韧带手术的初次 ACLR。使用 Kaplan-Meier 分析计算 2 年时的翻修率。使用多变量 Cox 回归分析估计 2 年内翻修的风险比（HR），并以翻修为终点。记录术前和 2 年时患者报告的结果变化，通过膝关节损伤和骨关节炎结果评分（KOOS）亚类“运动”和“生活质量”进行测量，对于未进行翻修的患者，采用多元线性回归进行分析。
共确定了 24790 例初次 ACLR，其中 10924 例采用 BPTB，13263 例采用 HT，603 例采用 QT 移植物。QT 组患者年龄较小（23.5 岁），其中更多为女性（58.2%），超过 50%的患者在受伤后 3 个月内接受手术。QT 组半月板损伤的患病率最高（61.9%）。2 年时的翻修估计值分别为 QT、HT 和 BPTB 的 3.6%、2.5%和 1.2%（p<0.001）。在以 QT 为参照的 Cox 回归分析中，BPTB 的翻修风险较低（HR 0.4，95%CI 0.2-0.7，p<0.001）。QT 与 HT 之间的翻修风险无显著差异（HR 1.1，95%CI 0.7-1.8，n.s.）。报告的最常见两次翻修原因是：创伤性移植物破裂和非创伤性移植物失效。在 2 年随访时，各组患者在 KOOS 亚类“运动”和“生活质量”的变化上没有差异。
初次 ACLR 后采用 QT 移植物的 2 年翻修风险高于 BPTB，与 HT 相似。各组患者在患者报告的结果上没有差异。本研究为初次 ACL 重建中自体移植物的选择提供了有价值的参考，有助于外科医生和患者做出决策。
II 级。
