Department of Orthopedics, Trondheim University Hospital, Trondheim, Norway.
Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Am J Sports Med. 2024 Sep;52(11):2750-2757. doi: 10.1177/03635465241271524. Epub 2024 Sep 2.
Bone-patellar tendon-bone (BPTB) and double-looped semitendinosus and gracilis (hamstring) grafts are commonly used for anterior cruciate ligament (ACL) reconstruction. Short-term and midterm studies show little or no differences between the 2 grafts; however, there are only a few long-term studies to compare results between the 2 grafts.
To compare the results after using either BPTB grafts or hamstring tendon grafts 18 years after ACL reconstruction.
Randomized controlled trial; Level of evidence 2.
A total of 114 patients with ACL rupture between 2001 and 2004 were randomized to reconstruction with either a BPTB graft or a hamstring tendon graft. Patients were operated on at 4 major hospitals. The 18-year follow-up evaluation included anterior knee laxity measured with a KT-1000 arthrometer, defined as the primary outcome, while clinical examination (Lachman and pivot-shift tests), isokinetic testing of muscle strength, patient-reported outcome measures, and an assessment of radiographic osteoarthritis using the Kellgren-Lawrence classification were defined as secondary outcomes.
A total of 96 patients (84%, 47 BPTB and 49 hamstring grafts) were available for follow-up, 71 of these for clinical examination. Seven of 96 patients were excluded for ACL revision (n = 5) or knee replacement (n = 2) surgery. In total, 25 patients (10 BPTB and 15 hamstring grafts) had undergone additional surgery other than ACL revision or total knee arthroplasty. There were no significant differences between the groups in terms of anterior laxity test with KT-1000 arthrometer (primary outcome). In secondary outcomes, no significant differences between groups were reported regarding clinical examination, patient-reported outcome scores, or radiographic osteoarthritis (Kellgren-Lawrence grade 2-4 for patellofemoral joint [18 hamstring and 14 BPTB] or tibiofemoral joint [20 hamstring and 19 BPTB]), while isokinetic testing revealed that the hamstring group had a 10.7% reduction in mean peak flexion torque compared with the BPTB group at 60 deg/s ( = 59; = .011). At 60 deg/s the mean total flexion work in the hamstring group was reduced by 17.2% compared with the BPTB group ( = 59; = .002).
The flexion strength in the hamstring group was significantly reduced in the operated knee after 18 years. There were no significant differences between the groups regarding subjective outcomes, patient-reported outcomes, range of motion, clinical and instrumented knee laxity, and the development of osteoarthritis.
NCT05876013 (ClinicalTrials.gov identifier).
骨-髌腱-骨（BPTB）和双股半腱肌和股薄肌（肌腱）移植物常用于前交叉韧带（ACL）重建。短期和中期研究表明，这两种移植物之间几乎没有或没有差异；然而，只有少数长期研究比较了这两种移植物的结果。
比较 18 年后使用 BPTB 移植物或肌腱移植物进行 ACL 重建的结果。
随机对照试验；证据等级 2。
2001 年至 2004 年间共有 114 例 ACL 断裂患者被随机分为 BPTB 移植物或肌腱移植物重建组。患者在 4 家大医院接受手术。18 年的随访评估包括使用 KT-1000 关节测量仪测量的前膝松弛度，这是主要结果，而临床检查（Lachman 和枢轴转移试验）、等速肌力测试、患者报告的结果测量和使用 Kellgren-Lawrence 分级评估的放射学骨关节炎被定义为次要结果。
共有 96 例患者（84%，47 例 BPTB 和 49 例肌腱移植物）可进行随访，其中 71 例可进行临床检查。96 例患者中有 7 例因 ACL 翻修（n=5）或膝关节置换（n=2）手术而被排除。共有 25 例患者（10 例 BPTB 和 15 例肌腱移植物）除 ACL 翻修或全膝关节置换外还接受了其他手术。在使用 KT-1000 关节测量仪的前松弛测试（主要结果）方面，两组间无显著差异。在次要结果方面，两组在临床检查、患者报告的结果评分或放射学骨关节炎方面无显著差异（髌股关节[18 例肌腱和 14 例 BPTB]或胫股关节[20 例肌腱和 19 例 BPTB]的 Kellgren-Lawrence 分级 2-4），而等速测试显示，在 60 度/秒时，肌腱组的平均峰值屈曲扭矩比 BPTB 组减少了 10.7%（=59；=0.011）。在 60 度/秒时，肌腱组的总屈曲功比 BPTB 组减少了 17.2%（=59；=0.002）。
18 年后，肌腱组的膝关节在运动时的屈曲力明显减弱。两组在主观结果、患者报告的结果、关节活动度、临床和仪器测量的膝关节松弛度以及骨关节炎的发展方面均无显著差异。
NCT05876013（ClinicalTrials.gov 标识符）。
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