Hospital for Special Surgery, New York, NY, USA.
Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Foot Ankle Int. 2024 Apr;45(4):348-356. doi: 10.1177/10711007241227418. Epub 2024 Mar 3.
The proposed advantages of hamstring autograft reconstruction when compared to alternative procedures, such as flexor hallucis longus (FHL) transfer, V-Y lengthening, and allograft reconstruction, are improved healing and reproduction of normal tendon biomechanics and reduced morbidity within the foot and ankle. In this study, we examined the effect of Achilles tendon reconstruction using hamstring autografts on strength and functional outcomes.
Patients who underwent Achilles repair with a hamstring autograft for insertional or midsubstance tendinopathy, delayed diagnosis of rupture, or infection after primary repair were evaluated for inclusion. Forty-six patients were identified; 12 further augmented with an FHL transfer are included in the analysis. Isokinetic testing was completed with a Biodex dynamometer under supervision of a physical therapist masked to surgical side. Pre- and postoperative Foot and Ankle Outcome Scores (FAOS, before March 2016) or Patient-Reported Outcomes Measurement Information System (PROMIS, after March 2016) surveys were collected.
For knee flexion, peak torque was not significantly different when comparing operative and nonoperative sides at 180 degrees/second (45.38 Nm vs 45.96 Nm; = .69) nor at 300 degrees/second (44.2 Nm vs 47.02 Nm; = .069). Knee extension absolute peak torque was only found to be significantly weaker on the operative side at the faster testing (75.5 Nm vs 79.56 Nm; < .05). Peak ankle plantarflexion torque was significantly weaker on the operative side at both the slower speed (60 degrees/second: 39.9 Nm vs 48.76 Nm; < .005) and the faster speed (120 degrees/second: 31.3 Nm vs 40.7 Nm; < .001). Average power for ankle plantarflexion did not differ significantly from the operative side to the nonoperative side in the slower test (26.46 W vs 27.48 W; = .60) but did significantly differ on the faster test (32.13 W vs 37.63 W; = .041). At an average of 19.9 months postoperation, all physical function and pain-related patient-reported outcome scores showed clinically and statistically significant improvement.
Achilles reconstruction with a hamstring autograft ± FHL transfer allowed patients with severe Achilles pathology to return to good subjective function, with modest deficits in calf strength compared with the uninjured side. Overall knee flexion strength did not appear impaired. These results suggest that hamstring autograft reconstruction is a viable method to treat these complex cases involving a lack of healthy tissue, allowing patients to return to symptom-free physical function and athletic activity.
Level IV, case series.
与其他手术方法（如踇长屈肌腱转位、V-Y 延长和同种异体重建）相比，采用半腱肌重建跟腱具有愈合改善和恢复正常肌腱生物力学以及减少足踝部发病率等优势。本研究旨在探讨采用自体半腱肌重建跟腱对跟腱强度和功能结果的影响。
纳入因插入部或腱中病变、延迟诊断的断裂、初次修复后感染而接受跟腱修复的采用自体半腱肌重建的患者。共纳入 46 例患者，其中 12 例进一步采用踇长屈肌腱转位增强。在物理治疗师的监督下，使用 Biodex 测力计进行等速测试，该治疗师对手术侧不知情。收集术前和术后足踝结果评分（FAOS，在 2016 年 3 月之前）或患者报告的结局测量信息系统（PROMIS，在 2016 年 3 月之后）的调查结果。
在 180 度/秒时，膝关节屈曲时，手术侧和非手术侧的峰值扭矩无显著差异（45.38 Nm 比 45.96 Nm； = .69），在 300 度/秒时也无显著差异（44.2 Nm 比 47.02 Nm； = .069）。只有在更快的测试中，手术侧的膝关节伸展绝对峰值扭矩明显较弱（75.5 Nm 比 79.56 Nm； < .05）。在较慢的速度（60 度/秒：39.9 Nm 比 48.76 Nm； < .005）和较快的速度（120 度/秒：31.3 Nm 比 40.7 Nm； < .001）时，手术侧的踝关节跖屈峰值扭矩明显较弱。在较慢的测试中，踝关节跖屈的平均功率与手术侧无显著差异（26.46 W 比 27.48 W； = .60），但在较快的测试中，差异有统计学意义（32.13 W 比 37.63 W； = .041）。在平均 19.9 个月的术后随访中，所有物理功能和与疼痛相关的患者报告结局评分均显示出显著的临床和统计学改善。
采用自体半腱肌重建跟腱结合踇长屈肌腱转位可以使严重跟腱病变的患者恢复良好的主观功能，但与健侧相比，小腿力量仍存在中度缺陷。总体而言，膝关节的屈曲力量似乎没有受损。这些结果表明，自体半腱肌重建是一种可行的方法，可以治疗这些复杂的病例，这些病例涉及缺乏健康组织，使患者能够恢复无症状的体力功能和运动活动。
IV 级，病例系列研究。
