Giusti Simone, Susca Marco, Cerulli Simona, De Fenu Edoardo, Adriani Ezio
Complex Operational Unit of Sports Traumatology and Joint Reconstruction, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
Adv Orthop. 2025 May 19;2025:8833546. doi: 10.1155/aort/8833546. eCollection 2025.
Graft choice, together with operative technique, remains the most controversial topic surrounding ACL reconstruction. The ideal graft choice should recreate normal anatomy and biomechanics, allow for rapid return to play and have minimal harvest-site morbidity. The purposes of this study were to compare donor-site morbidity in all-soft-tissue quadriceps autograft vs. hamstring autografts based on Hacken et al.'s ACL Donor-Site Morbidity Questionnaire (32,587,874) and to assess the role played by external factors such as sex, mood, activity level and smoking status. We performed a retrospective analysis of our patients' records to identify individuals who were 30 years old or younger at the time of surgery and underwent ACL reconstruction using the anteromedial portal technique, without any additional treatments for ligament or meniscal injuries. At 12 months postintervention, donor-site morbidity was evaluated using the ACL donor-site morbidity questionnaire by Hacken et al. (2020). Analyses were performed using Jamovi freeware Version 2.3.19.0 (the Jamovi project, 2021). Independent samples t-test with Cohen's d as the effects' size statistics were used to compare donor-site morbidity and functional outcomes. Significant differences between quadriceps tendon (QT) and STG groups were found for ACL donor-site morbidity questionnaire total score, numbness, size of numbness and muscle atrophy, all in favour of the QT cohort. Weak associations were found between female sex and low mood, both negatively impacting the reported donor site morbidity. No statistically significant differences were found for functional outcomes. ACL reconstruction with all-soft-tissue QT autograft showed overall superior donor-site morbidity outcomes when compared with HT autograft. Statistically significant results were also found in favour of QT when comparing numbness and size of numbness at the donor site and self-perceived muscle atrophy. Female sex and low mood have been found to impact donor-site morbidity negatively although larger samples are necessary to confirm this association. Graft choice in ACL reconstruction should always remain an individualized choice, but QT should be considered an equal, if not superior, alternative to other autologous autografts when comparing donor-site morbidity. CINECA: 6458.
移植物的选择与手术技术一起，仍然是围绕前交叉韧带（ACL）重建最具争议的话题。理想的移植物选择应能重建正常的解剖结构和生物力学，允许患者快速恢复运动，且取腱部位的发病率最低。本研究的目的是基于哈肯等人的ACL供体部位发病率问卷（32,587,874），比较全软组织股四头肌自体移植物与腘绳肌自体移植物的供体部位发病率，并评估性别、情绪、活动水平和吸烟状况等外部因素所起的作用。我们对患者的记录进行了回顾性分析，以确定手术时年龄在30岁及以下、采用前内侧入路技术进行ACL重建且未对韧带或半月板损伤进行任何额外治疗的个体。在干预后12个月，使用哈肯等人（2020年）的ACL供体部位发病率问卷对供体部位发病率进行评估。使用Jamovi免费软件版本2.3.19.0（Jamovi项目，2021年）进行分析。采用以科恩d值作为效应量统计量的独立样本t检验来比较供体部位发病率和功能结果。在ACL供体部位发病率问卷总分、麻木感、麻木面积和肌肉萎缩方面，发现股四头肌腱（QT）组和半腱肌-股薄肌（STG）组之间存在显著差异，所有结果均有利于QT组。发现女性性别与情绪低落之间存在弱关联，二者均对报告的供体部位发病率产生负面影响。在功能结果方面未发现统计学上的显著差异。与腘绳肌自体移植物相比，全软组织股四头肌自体移植物进行ACL重建显示出总体上更好的供体部位发病率结果。在比较供体部位的麻木感和麻木面积以及自我感知的肌肉萎缩时，也发现了有利于QT组的统计学显著结果。已发现女性性别和情绪低落会对供体部位发病率产生负面影响，尽管需要更大的样本量来证实这种关联。ACL重建中的移植物选择应始终是个性化的选择，但在比较供体部位发病率时，QT应被视为与其他自体移植物同等甚至更优的选择。 计算中心：6458
