与使用腘绳肌腱自体移植物和胫骨隧道钻孔重建相比，接受前交叉韧带重建伴髌腱自体移植物和前内侧钻孔的年轻男性在 5 至 10 年随访时，在移植物稳定性和活动水平方面表现更好。
Young men undergoing anterior cruciate ligament reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to those undergoing reconstruction with hamstring autograft and transtibial drilling.
机构信息
Department of Orthopedic Surgery, Meir Medical Center, Kfar Saba 44281, Israel; Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 69978, Israel.
Department of Orthopedic Surgery, Barzilai Medical Center, Ashkelon 7845637, Israel; The Joyce & Irving Goldman Faculty of Medicine, Ben-Gurion University of the Negev, Beer Sheva 8443944, Israel.
出版信息
J ISAKOS. 2024 Aug;9(4):540-548. doi: 10.1016/j.jisako.2024.04.001. Epub 2024 Apr 3.
OBJECTIVE
To compare 5- to 10-year outcomes of anterior cruciate ligament (ACL) reconstruction in young men performed with bone-patellar tendon bone (BPTB) autograft and anteromedial portal to reconstruction with hamstring autograft and transtibial technique. It was hypothesised that in young adult men, at 5- to 10-year follow-up, superior restoration of knee laxity and activity levels would be demonstrated using BPTB autograft and anteromedial portal technique.
METHODS
Ninety-four men who had ACL reconstruction with BPTB autograft and anteromedial portal were eligible for comparison to 106 men who had reconstruction with hamstring autograft and transtibial technique. Inclusion criteria were: (1) age 18-35 years, (2) ACL tear caused by sports trauma only, (3) no concomitant ligament reconstruction and (4) 5- to 10-year follow-up. Outcome measures compared between the two groups included Lachman and pivot shift tests, KT side-to-side difference, Tegner and Marx scores, International Knee Documentation Committee (IKDC)-subjective score, Knee Osteoarthritis Outcome Scale (KOOS), Short Form (SF)-36, and single hop test for distance. P value < 0.05 indicated statistical significance.
RESULTS
Forty-five patients with BPTB and 55 patients with hamstring ACL reconstruction were available for in-person assessment at 5-10 years after surgery. Outcomes in the BPTB group compared to the hamstring group showed KT difference 1.4 ± 1.9 mm vs. 2.8 ± 2.3 mm (p < 0.01), pivot shift grade 2-3 in 4% vs. 34% (p < 0.01), return to preinjury Tegner level in 51% vs. 36% (p = 0.1) and to preinjury Marx score in 29% vs. 11% (p = 0.02), and IKDC-subjective 88 ± 10 vs. 82 ± 13 vs (p < 0.01), respectively. Statistically significant inter-relationships were found between KT side-to-side difference and the Tegner, Marx and IKDC-subjective scores at follow-up (r = -0.314, p < 0.01; r = -0.263, p < 0.01; r = -0.218, p = 0.03, respectively).
CONCLUSION
Young men undergoing ACL reconstruction with patellar tendon autograft and anteromedial drilling outperform at 5- to 10-year follow-up in terms of graft stability and activity levels compared to young men undergoing reconstruction with hamstring autograft and transtibial drilling.
LEVEL OF EVIDENCE
III (Retrospective cross-sectional comparative study).
目的
比较使用骨-髌腱-骨（BPTB）自体移植物进行前交叉韧带（ACL）重建与使用腘绳肌腱自体移植物和经胫骨技术进行前内侧入路重建的 5-10 年结果。假设在年轻成年男性中，5-10 年随访时，使用 BPTB 自体移植物和前内侧入路技术可更好地恢复膝关节松弛度和活动水平。
方法
94 名接受 ACL 重建的男性符合使用 BPTB 自体移植物和前内侧入路与 106 名接受腘绳肌腱自体移植物和经胫骨技术重建的男性进行比较。纳入标准为：（1）年龄 18-35 岁，（2）ACL 撕裂由运动创伤引起，（3）无伴随的韧带重建，（4）5-10 年随访。两组之间比较的结果测量包括 Lachman 和枢轴转移试验、KT 侧间差异、Tegner 和 Marx 评分、国际膝关节文献委员会（IKDC）主观评分、膝关节骨关节炎结局评分（KOOS）、Short Form（SF）-36 和单足跳距离。P 值<0.05 表示具有统计学意义。
结果
94 名 BPTB 患者和 55 名腘绳肌腱 ACL 重建患者在手术后 5-10 年接受了面对面评估。BPTB 组与腘绳肌腱组的结果显示 KT 差异为 1.4±1.9 mm 与 2.8±2.3 mm（p<0.01），2-3 级枢轴转移试验为 4%与 34%（p<0.01），恢复到术前 Tegner 水平的为 51%与 36%（p=0.1），恢复到术前 Marx 评分的为 29%与 11%（p=0.02），IKDC 主观评分 88±10 与 82±13（p<0.01）。在随访时，KT 侧间差异与 Tegner、Marx 和 IKDC 主观评分之间存在统计学显著的相互关系（r=-0.314，p<0.01；r=-0.263，p<0.01；r=-0.218，p=0.03）。
结论
与接受腘绳肌腱自体移植物和经胫骨钻孔重建的年轻男性相比，接受髌腱自体移植物和前内侧钻孔重建的年轻男性在 5-10 年随访时，在移植物稳定性和活动水平方面表现更优。
证据水平
III（回顾性横截面比较研究）。
Zotero 插件