与使用腘绳肌自体移植进行前交叉韧带重建相比，骨-髌腱-骨自体移植在高水平运动员中恢复到伤前运动水平的比例更高。
Bone-patellar tendon-bone autograft is associated with a higher rate of return to preinjury levels of performance in high-level athletes than anterior cruciate ligament reconstruction using hamstring autograft.
作者信息
Tomihara Tomohiro, Hashimoto Yusuke, Okazaki Shiro, Nishino Kazuya, Taniuchi Masatoshi, Takigami Junsei, Tsumoto Shuko, Katsuda Hiroshi
机构信息
Department of Orthopaedic Surgery, Shimada Hospital, Habikino, Japan.
Department of Sport Sciences, Osaka University of Health and Sport Sciences, Sennan-gun, Japan.
出版信息
Knee Surg Sports Traumatol Arthrosc. 2024 Jun;32(6):1384-1395. doi: 10.1002/ksa.12144. Epub 2024 Apr 1.
PURPOSE
Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL-R) for athletes when ACL graft rupture is a career-threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL-R using bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft in high-level athletes with a minimum postoperative follow-up of 24 months.
METHODS
This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL-R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow-ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow-ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury.
RESULTS
Ninety-nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL-R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty-three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300-5.160; p = 0.007) was associated with a higher potential for RTP after ACL-R. The incidence of ACL graft rupture after ACL-R decreased with BPTB (OR, 0.861; 95% CI, 0.770-0.962; p = 0.009).
CONCLUSIONS
The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL-R using HT autograft.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
目的
对于运动员而言，前交叉韧带重建术（ACL - R）后恢复到伤前的运动水平（RTP）是主要目标，因为前交叉韧带移植物破裂是一个危及职业生涯的事件。本研究的目的是阐明在至少术后随访24个月的高水平运动员中，采用髌腱 - 骨（BPTB）或腘绳肌（HT）自体移植物进行ACL - R后RTP以及随后ACL损伤的相关因素。
方法
这项回顾性研究纳入了157例伤前Tegner活动水平为9级且接受初次ACL - R的患者，其中采用BPTB自体移植物的患者（平均年龄16.9岁；男性35例，女性36例）和采用HT自体移植物的患者（平均年龄17.2岁；男性49例，女性37例）。BPTB组和HT组的平均随访时间分别为33.6个月和44.5个月。数据通过外科医生进行的常规临床随访和电话访谈获得。进行多因素逻辑回归分析以确定患者变量与RTP及随后ACL损伤之间的关联。
结果
99例患者（63.1%）能够恢复到伤前运动水平。BPTB组的RTP率（74.6%）显著高于HT组（53.5%）（p < 0.05）。ACL - R后RTP的总体平均时间为10.0个月，而BPTB组（9.7个月）明显早于HT组（10.5个月）（p < 0.05）。分别有23例（14.6%）和21例（13.4%）患者出现ACL移植物破裂和对侧膝关节ACL损伤。多因素分析表明，BPTB（优势比[OR]，2.590；95%置信区间[CI]，1.300 - 5.160；p = 0.007）与ACL - R后更高的RTP可能性相关。ACL - R后ACL移植物破裂的发生率在BPTB组较低（OR，0.861；95% CI，0.770 - 0.962；p = 0.009）。
结论
与采用HT自体移植物进行的ACL - R相比，采用BPTB自体移植物与更高的RTP率和更低的ACL移植物破裂发生率相关。
证据水平
IV级，回顾性病例系列。
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