Daniel Adam V, Smith Patrick A
The Columbia Orthopaedic Group, Columbia, Missouri, USA.
Orthop J Sports Med. 2024 Sep 26;12(9):23259671241270308. doi: 10.1177/23259671241270308. eCollection 2024 Sep.
The rate of failed anterior cruciate ligament reconstruction (ACLR) remains high in the younger and more active patient populations. Suture tape augmentation (STA) in addition to ACLR may reduce the risk for revision surgery.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare patient outcomes between patients who underwent primary all-inside quadrupled semitendinosus hamstring tendon autograft (QST-HTA) ACLR with and without STA. It was hypothesized that the STA cohort would demonstrate a lower incidence of subsequent revision ACLR while maintaining comparable patient-reported outcomes.
Cohort study; Level of evidence, 3.
All patients ≤40 years of age who received primary all-inside QST-HTA ACLR with and without independent STA augmentation were identified. The following validated patient-reported outcome measures (PROMs) were collected: visual analog scale for pain, Single Assessment Numeric Evaluation, Knee injury and Osteoarthritis Outcome Score subscales, and Tegner activity scale. KT-1000 arthrometer measurements were collected pre- and postoperatively. Cox proportional hazards model and nominal logistic regression analysis were used to assess additional variables associated with revision ACLR.
A total of 104 patients with a mean age of <22 years were included in the final data analysis (STA: 36 patients; control: 68 patients). Significantly fewer patients in the STA group sustained a graft failure necessitating revision surgery at the final follow-up (5.6% vs 24%; relative risk, 0.24 [95% CI, 0.06-0.97]; = .017). Four-year graft survival was significantly higher in the STA group (97.2% vs 82.4%; = .031). All PROMs significantly improved postoperatively except for Tegner levels, which decreased in both groups compared with their preinjury levels ( < .001). Return to sports was similar in both groups with >70% of patients returning to their previous level of competition. Regression analysis demonstrated increased risk for revision ACLR in younger patients, high school athletes, and those with higher postoperative activity levels.
QST-HTA ACLR with STA was associated with reduced risk for revision ACLR compared with nonaugmented QST-HTA ACLR in this young patient population. Furthermore, the addition of suture tape did not appear to affect postoperative patient-reported and return-to-sports outcomes.
在年轻且活动量较大的患者群体中，前交叉韧带重建术（ACLR）失败率依然很高。ACLR联合使用缝线带增强术（STA）可能会降低翻修手术的风险。
目的/假设：本研究旨在比较接受初次全内置四股半腱肌自体腘绳肌腱（QST-HTA）ACLR且有或无STA的患者的治疗效果。研究假设是，STA组后续ACLR翻修的发生率会更低，同时保持相当的患者报告结局。
队列研究；证据等级为3级。
纳入所有年龄≤40岁、接受初次全内置QST-HTA ACLR且有或无独立STA增强术的患者。收集以下经过验证的患者报告结局指标（PROMs）：疼痛视觉模拟量表、单项评估数值评定法、膝关节损伤和骨关节炎结局评分量表以及特格纳活动量表。术前和术后均收集KT-1000关节测径仪测量数据。采用Cox比例风险模型和名义逻辑回归分析来评估与ACLR翻修相关的其他变量。
最终数据分析共纳入104例平均年龄<22岁的患者（STA组：36例患者；对照组：68例患者）。在最终随访时，STA组因移植物失败而需要翻修手术的患者明显更少（5.6% 对24%；相对风险，0.24 [95% CI，0.06 - 0.97]；P = 0.017）。STA组4年移植物存活率显著更高（97.2% 对82.4%；P = 0.031）。除特格纳活动水平外，所有PROMs术后均显著改善，与伤前水平相比，两组的特格纳活动水平均下降（P < 0.001）。两组恢复运动的情况相似，超过70%的患者恢复到之前的比赛水平。回归分析表明，年轻患者、高中运动员以及术后活动水平较高的患者ACLR翻修风险增加。
在该年轻患者群体中，与未增强的QST-HTA ACLR相比，QST-HTA ACLR联合STA可降低ACLR翻修风险。此外，添加缝线带似乎并未影响术后患者报告的结局和恢复运动的情况。
