Nagai Kanto, Matsushita Takehiko, Zhang Shurong, Hoshino Yuichi, Nakanishi Yuta, Araki Daisuke, Nishida Kyohei, Kuroda Ryosuke
Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Asia Pac J Sports Med Arthrosc Rehabil Technol. 2025 Jun 4;41:1-5. doi: 10.1016/j.asmart.2025.04.006. eCollection 2025 Jul.
The present study was aimed to compare the clinical outcomes following double-bundle (DB) ACL reconstruction (ACLR) with the outcomes following single-bundle (SB) ACLR in skeletally mature teenagers.
A total of 113 skeletally mature teenagers with unilateral ACL injury, who underwent primary ACLR using hamstring autograft with minimum 2 years follow-up, were included. This included 82 DB ACLR (median 16.0 [interquartile range (IQR), 2.0] year-old, male/female: 21/61) and 31 SB ACLR (17.0 [2.0] year-old, male/female: 6/25). At the final follow-up (3.6 [1.9] years), IKDC Subjective Knee Form (IKDC-SKF), Tegner activity scale, the side-to-side difference (SSD) in anterior tibial translation using KT arthrometer were obtained. The rate of residual pivot-shift test, graft rupture rate and contralateral ACL injury rate were also assessed.
The rate of residual pivot-shift test was significantly lower in DB group than SB group (12.0 % vs 33.3 %, P = 0.02). Postoperative Tegner activity scale was significantly greater in DB group (7 [2]) than SB group (4 [4], P = 0.002). No significant differences were observed between two groups in IKDC-SKF (96.6 [10.0] in DB group, 97.7 [9.0] in SB group) and SSD in anterior tibial translation (1.5 [2.0] mm in DB group, 2.0 [2.0] mm in SB group). Graft rupture occurred in seven patients in DB group (8.5 %), and one patient in SB group (3.3 %). Contralateral ACL injury occurred in four patients in DB group (4.9 %), and two patients in SB group (6.5 %). No significant differences were observed between two groups in graft rupture and the contralateral ACL injury rates.
Clinical outcomes following DB ACLR were similar to SB ACLR, but the pivot-shift phenomenon appeared to be better controlled in DB ACLR than SB ACLR. Thus, to better restore rotatory knee stability, DB ACLR may be recommended in the skeletally mature teenagers.
III.
本研究旨在比较在骨骼成熟青少年中，双束（DB）前交叉韧带重建术（ACLR）与单束（SB）ACLR后的临床结果。
共纳入113例单侧前交叉韧带损伤的骨骼成熟青少年，他们接受了自体腘绳肌腱移植的初次ACLR，且随访至少2年。其中包括82例DB ACLR（年龄中位数16.0岁[四分位间距（IQR），2.0]，男/女：21/61）和31例SB ACLR（17.0岁[2.0]，男/女：6/25）。在末次随访时（3.6年[1.9]），获取国际膝关节文献委员会主观膝关节评分表（IKDC-SKF）、Tegner活动量表、使用KT关节测量仪测量的胫骨前移的双侧差值（SSD）。还评估了残余轴移试验率、移植物破裂率和对侧前交叉韧带损伤率。
DB组的残余轴移试验率显著低于SB组（12.0%对33.3%，P = 0.02）。DB组术后Tegner活动量表评分显著高于SB组（7[2]对4[4]，P = 0.）。两组在IKDC-SKF评分（DB组为96.6[10.0]，SB组为97.7[9.0]）和胫骨前移SSD方面（DB组为1.5[2.0]mm，SB组为2.0[2.0]mm）未观察到显著差异。DB组有7例患者发生移植物破裂（8.5%），SB组有1例患者发生移植物破裂（3.3%）。DB组有4例患者发生对侧前交叉韧带损伤（4.9%），SB组有2例患者发生对侧前交叉韧带损伤（6.5%）。两组在移植物破裂率和对侧前交叉韧带损伤率方面未观察到显著差异。
DB ACLR后的临床结果与SB ACLR相似，但DB ACLR对轴移现象的控制似乎优于SB ACLR。因此，为更好地恢复膝关节旋转稳定性，对于骨骼成熟的青少年，推荐采用DB ACLR。
III级
