Lindskog Jakob, Högberg Johan, Hamrin Senorski Rebecca, Piussi Ramana, Zsidai Bálint, Samuelsson Kristian, Thomeé Roland, Hamrin Senorski Eric
Sportrehab Sports Medicine Clinic, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden; Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Sportrehab Sports Medicine Clinic, Gothenburg, Sweden; Sahlgrenska Sports Medicine Center, Sahlgrenska Academy, Gothenburg, Sweden.
Arthroscopy. 2025 Sep;41(9):3336-3345.e1. doi: 10.1016/j.arthro.2025.01.028. Epub 2025 Jan 30.
To examine the rate of (1) second anterior cruciate ligament (ACL) rupture (graft rupture or contralateral ACL rupture) and (2) graft rupture alone in patients with generalized joint hypermobility (GJH) at 12 months, at 24 months, and at the longest available time (LAT) following return to sport (RTS) after ACL reconstruction depending on graft choice, that is, hamstring tendon (HT) autograft or bone-patellar tendon-bone (BPTB) autograft.
Data were extracted from a rehabilitation registry that comprised patients who had undergone ACL reconstruction between 2014 and 2022. Patients with GJH aged between 16 and 50 years who had minimum 24-month follow-up following RTS after ACL reconstruction with HT autograft (GJH-HT) or BPTB autograft (GJH-BPTB) were included. A Cox proportional hazard regression model was used to examine the rate of (1) second ACL rupture (graft rupture or contralateral ACL rupture) and (2) graft rupture alone at 12 months, at 24 months, and at the LAT after RTS.
This study included 82 patients (54 in the GJH-HT group and 28 in the GJH-BPTB group), of whom 72.0% were female patients, and the average age was 22.7 ± 7.4 years. The proportion of second ACL ruptures was greater in the GJH-HT group than in the GJH-BPTB group at 12 months (11 of 54 [20.4%] vs 0 of 28 [0%], P = .013), at 24 months (13 of 54 [24.1%] vs 1 of 28 [3.6%], P = .028), and at the LAT (16 of 54 [29.6%] vs 2 of 28 [7.1%], P = .024) after RTS. The rate of second ACL rupture was greater in the GJH-HT group than in the GJH-BPTB (hazard ratio = 4.98, P = .032) at the LAT after RTS. The proportion of patients with graft rupture was greater in the GJH-HT group than in the GJH-BPTB group at 12 months (8 of 54 [14.8%] vs 0 of 28 [0%], P = .046), at 24 months (10 of 54 [18.5%] vs 0 of 28 [0%], P = .013), and at the LAT (12 of 54 [22.2%] vs 0 of 28 [0%], P = .006) after RTS.
An over 4 times greater rate of second ACL rupture after RTS was reported for patients with GJH who underwent ACL reconstruction with HT autograft compared with BPTB autograft. Patients with GJH who were treated with BPTB autograft for ACL reconstruction did not experience graft rupture after RTS.
Level III, retrospective study.
研究在接受前交叉韧带（ACL）重建后恢复运动（RTS）的12个月、24个月以及最长可随访时间（LAT）时，根据移植物选择（即腘绳肌腱（HT）自体移植物或骨-髌腱-骨（BPTB）自体移植物），全身关节过度活动（GJH）患者中（1）第二次ACL断裂（移植物断裂或对侧ACL断裂）和（2）单纯移植物断裂的发生率。
从一个康复登记处提取数据，该登记处包含2014年至2022年间接受ACL重建的患者。纳入年龄在16至50岁之间、接受HT自体移植物（GJH-HT）或BPTB自体移植物（GJH-BPTB）进行ACL重建后RTS至少随访24个月的GJH患者。使用Cox比例风险回归模型研究RTS后12个月、24个月和LAT时（1）第二次ACL断裂（移植物断裂或对侧ACL断裂）和（2）单纯移植物断裂的发生率。
本研究纳入82例患者（GJH-HT组54例，GJH-BPTB组28例），其中72.0%为女性患者，平均年龄为22.7±7.4岁。在RTS后的12个月（54例中的11例[20.4%] vs 28例中的0例[0%]，P = 0.013）、24个月（54例中的13例[24.1%] vs 28例中的1例[3.6%]，P = 0.028）和LAT（54例中的16例[29.6%] vs 28例中的2例[7.1%]，P = 0.024）时，GJH-HT组第二次ACL断裂的比例高于GJH-BPTB组。在RTS后的LAT时，GJH-HT组第二次ACL断裂的发生率高于GJH-BPTB组（风险比 = 4.98，P = 0.032）。在RTS后的12个月（54例中的8例[14.8%] vs 28例中的0例[0%]，P = 0.046）、24个月（54例中的10例[18.5%] vs 28例中的0例[0%]，P = 0.013）和LAT（54例中的12例[22.2%] vs 28例中的0例[0%]，P = 0.006）时，GJH-HT组移植物断裂患者的比例高于GJH-BPTB组。
与BPTB自体移植物相比，接受HT自体移植物进行ACL重建的GJH患者在RTS后第二次ACL断裂的发生率高出4倍多。接受BPTB自体移植物进行ACL重建治疗的GJH患者在RTS后未发生移植物断裂。
III级，回顾性研究。
