Rhim Hye Chang, Lee Jin Hyuck, Lee Seo Jun, Kang Chun Hyung, Han Seung-Beom, Jang Ki-Mo
Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA.
Department of Orthopaedic Surgery, Foot & Ankle Research and Innovation Lab, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
Orthop J Sports Med. 2025 Jan 20;13(1):23259671241303752. doi: 10.1177/23259671241303752. eCollection 2025 Jan.
Graft selection is an important part of preoperative planning for anterior cruciate ligament reconstruction (ACLR). In addition, ACLR with the remnant preservation technique has recently gained attention due to potential benefit in bone-tendon healing, graft revascularization, and proprioceptive nerve remodeling. However, the ideal graft choice remains controversial, and there is limited research comparing autograft and allograft in ACLR with remnant preservation.
To compare knee muscle strength, neuromuscular control, and patient-reported outcomes between hamstring (HS) tendon autografts and tibialis anterior (TA) allografts in patients undergoing ACLR with remnant preservation through posterior transseptal portal for >1 year.
Cohort study; Level of evidence, 3.
A total of 70 patients who underwent ACLR with remnant preservation between 2018 and 2021 using HS tendon autograft (n = 35) or TA allograft (n = 35) were analyzed at 3 different time points (preoperative, 6 months, and 12 months). Quadriceps and HS muscle strengths were measured with an isokinetic device. Proprioception was evaluated with reproduction of passive positioning for joint position sense and overall stability index (OSI) for dynamic postural stability. Patient-reported outcomes included the Lysholm score and the International Knee Documentation Committee score.
There were no significant differences in demographic information including age, body mass index, concomitant meniscal injuries, and sports activities ( > .05) between HS tendon autograft and TA allograft groups. Quadriceps and HS strength in both groups, HS strength in deep knee flexion in both groups, and OSI in the HS tendon autograft group significantly improved at 12 months ( < .05). Repeated-measures analysis of variance revealed significant interactions between time and grafts for OSI ([2, 136] = 5.08; = .007). The subsequent independent test demonstrated that the OSI was significantly higher in the TA allograft group (2.7 ± 1.0) than that of the HS tendon autograft group (2.1 ± 0.8) at 12 months ( = .009), indicating better dynamic postural stability in the HS tendon autograft group.
No significant differences were found in knee muscle strength or patient-reported outcomes between HS tendon autograft and TA allograft after ACLR with remnant preservation for up to 1 year except for dynamic postural stability favoring HS tendon autograft.
移植物的选择是前交叉韧带重建（ACLR）术前规划的重要组成部分。此外，保留残端技术的ACLR近来因在骨-肌腱愈合、移植物血管再生和本体感觉神经重塑方面的潜在益处而受到关注。然而，理想的移植物选择仍存在争议，且在保留残端的ACLR中比较自体移植物和异体移植物的研究有限。
比较通过后间隔入路行保留残端的ACLR超过1年的患者中，腘绳肌（HS）肌腱自体移植物和胫骨前肌（TA）异体移植物在膝关节肌肉力量、神经肌肉控制和患者报告结局方面的差异。
队列研究；证据等级：3级。
对2018年至2021年间共70例行保留残端的ACLR的患者进行分析，其中35例采用HS肌腱自体移植物，35例采用TA异体移植物，在3个不同时间点（术前、6个月和12个月）进行评估。使用等速装置测量股四头肌和HS肌肉力量。通过被动定位复制评估关节位置觉的本体感觉，并通过动态姿势稳定性的整体稳定性指数（OSI）进行评估。患者报告结局包括Lysholm评分和国际膝关节文献委员会评分。
HS肌腱自体移植物组和TA异体移植物组在人口统计学信息（包括年龄、体重指数、合并半月板损伤和体育活动情况）方面无显著差异（P>0.05）。两组的股四头肌和HS力量、两组在屈膝时的HS力量以及HS肌腱自体移植物组的OSI在12个月时均显著改善（P<0.05）。重复测量方差分析显示，OSI在时间和移植物之间存在显著交互作用（F[2, 136]=5.08；P=0.007）。随后的独立t检验表明，12个月时TA异体移植物组的OSI（2.7±1.0）显著高于HS肌腱自体移植物组（2.1±0.8）（P=0.009），表明HS肌腱自体移植物组的动态姿势稳定性更好。
在保留残端的ACLR术后长达1年的时间里，HS肌腱自体移植物和TA异体移植物在膝关节肌肉力量或患者报告结局方面未发现显著差异，但HS肌腱自体移植物的动态姿势稳定性更佳。
