Johnson Bailey E, Smith Chelsea L, Smith Cory D, Quilligan Edward J, Deshpande Viraj A, Gardner Vance O, Parvaresh Kevin C, Shepard Michael F, Petrie Russell S, Prietto Carlos A, Grumet Robert C, Gazzaniga David S
Hoag Orthopedic Institute, Irvine, California, USA.
Orthop J Sports Med. 2025 Feb 6;13(2):23259671241311916. doi: 10.1177/23259671241311916. eCollection 2025 Feb.
Arthrofibrosis is a complication of anterior cruciate ligament reconstruction (ACLR), and it is possible that graft choice such as the quadriceps tendon (QT) autograft may be a risk factor. With the increasing popularity of the QT autograft, it is important to compare it with other graft choices.
PURPOSE/HYPOTHESIS: The purpose of this study was to identify whether graft choice, QT versus bone-patellar tendon-bone (BTB) autograft, is a risk factor for early return to the operating room for arthrofibrosis after ACLR. It was hypothesized that the rate of arthrofibrosis surgery would be higher for the QT autograft recipients.
Cohort study; Level of evidence, 3.
A single-center retrospective chart review was conducted between January 2010 and November 2022. Skeletally mature patients who underwent primary ACLR with either QT or BTB autograft were considered for inclusion. Patients who received an alternate graft or those undergoing revision ACLR were excluded. The primary outcome of interest was return to the operating room for arthrofibrosis release (either manipulation under anesthesia or lysis of adhesions).
Of 1726 included patients (1155 receiving a BTB autograft and 571 receiving a QT autograft), 5.2% (n = 60) of BTB recipients and 6.5% (n = 37) of QT recipients required subsequent arthrofibrosis. There was no significant association between graft type and subsequent arthrofibrosis ( = .275). There was a significant association with graft type and presence of a cyclops lesion (65.0% of BTB grafts and 40.5% of QT grafts; = .018). After removing those patients with chronic tears who underwent ACLR at >1 year, patients who required arthrofibrosis were found to have a significantly shorter time between injury and ACLR (mean, 59.23 ± 48.46 days) than those who did not require arthrofibrosis (mean, 81.7 ± 72.63 days) (≤ .01). Significantly more female patients (9.25%) than male patients (2.79%) required arthrofibrosis (hazard ratio, 3.82; < .001), and patients who required arthrosis were significantly younger (mean, 22.52 ± 9.35 years) than those who did not (mean, 25.74 ± 10.83 years) ( = .001).
Study findings indicated no statistically significant difference in the rate of secondary arthrofibrosis surgery between patients who underwent ACLR with either QT or BTB autograft.
关节纤维化是前交叉韧带重建（ACLR）的一种并发症，股四头肌肌腱（QT）自体移植物等移植物选择可能是一个风险因素。随着QT自体移植物越来越受欢迎，将其与其他移植物选择进行比较很重要。
目的/假设：本研究的目的是确定移植物选择（QT与骨-髌腱-骨（BTB）自体移植物）是否是ACLR后因关节纤维化而早期返回手术室的风险因素。假设QT自体移植物接受者的关节纤维化手术发生率会更高。
队列研究；证据等级，3级。
在2010年1月至2022年11月期间进行了一项单中心回顾性图表审查。纳入接受QT或BTB自体移植物进行初次ACLR的骨骼成熟患者。接受替代移植物的患者或接受ACLR翻修的患者被排除。感兴趣的主要结局是因关节纤维化松解（麻醉下手法操作或粘连松解）返回手术室。
在1726例纳入患者中（1155例接受BTB自体移植物，571例接受QT自体移植物），BTB接受者中有5.2%（n = 60），QT接受者中有6.5%（n = 37）需要后续进行关节纤维化治疗。移植物类型与后续关节纤维化之间无显著关联（P = 0.275）。移植物类型与独眼病变的存在有显著关联（BTB移植物为65.0%，QT移植物为40.5%；P = 0.018）。在排除那些受伤超过1年进行ACLR的慢性撕裂患者后，发现需要进行关节纤维化治疗的患者受伤与ACLR之间的时间显著短于不需要进行关节纤维化治疗的患者（平均，59.23±48.46天）（平均，81.7±72.63天）（P≤0.01）。需要进行关节纤维化治疗的女性患者（9.25%）显著多于男性患者（2.79%）（风险比，3.82；P<0.001），需要进行关节纤维化治疗的患者明显比不需要的患者年轻（平均，22.52±9.35岁）（平均，25.74±10.83岁）（P = 0.001）。
研究结果表明，接受QT或BTB自体移植物进行ACLR的患者在二次关节纤维化手术发生率上无统计学显著差异。
