Lower Risk of Revision With Patellar Tendon Autografts Compared With Hamstring Autografts
Lower Risk of Revision With Patellar Tendon Autografts Compared With Hamstring Autografts
复制标题
与自体腿筋移植相比，自体髌腱修复的风险较低
DOI：
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发表时间：
2014
影响因子：
4.8
通讯作者：
J. O. Drogset
中科院分区：
文献类型：
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作者：
Tone Gifstad;O. Foss;L. Engebretsen;M. Lind;M. Forssblad;G. Albrektsen;J. O. Drogset
背景资料：许多研究发现，自体髌腱移植物和自体腘绳肌移植物重建前交叉韧带（ACL）后的结果相当;然而，很少有研究足够大，以揭示临床和人口统计学因素方面的翻修风险差异。目的：根据斯堪的纳维亚ACL登记研究的数据，介绍ACL重建的移植物分布，并比较髌腱自体移植物和腘绳肌自体移植物的翻修风险。还探讨了与其他临床和人口统计学因素的潜在关联。研究设计：队列研究;证据等级2。研究方法：在斯堪的纳维亚ACL登记系统中，共识别出45，998例初次ACL重建，包括6736例髌腱自体移植物和38，666例腘绳肌自体移植物。总体中位随访时间为3年（范围：0-8年）。为了比较患者组之间的翻修风险，应用单变量Kaplan-Meier分析（对数秩检验）和考克斯比例风险回归模型。将风险率比和95% CI报告为效应指标。结果：自体髌腱和腘绳肌移植分别占14.6%和84.1%。其余患者接受同种异体移植物、直接缝合或其他移植物类型（1.3%）。原发性ACL损伤发生在足球、团队手球或高山活动中，髌腱组67.5%的患者和腘绳肌组66.2%的患者发生。髌腱组共有156例患者，腘绳肌组共有1042例患者接受了翻修。髌腱组翻修的总体风险显著低于腘绳肌组（风险率比= 0.63; 95%CI，0.53-0.74），并且随着手术年龄的增加而降低，尽管不是严格线性的。在患者性别、年龄和伴随软骨损伤的亚组中，一致观察到髌腱组的翻修风险较低（P > 0.05，交互作用检验），但在某些旋转活动中受伤的患者中似乎稍微更明显（足球，团队手球和高山活动）与其他活动相比（风险率比= 0.57 vs 0.81; P = 0.058，相互作用检验）。结论：在斯堪的纳维亚，大多数初次ACL重建术均采用自体腘绳肌移植物。目前的大型前瞻性研究结果表明，与接受自体腘绳肌腱移植的患者相比，接受自体髌腱移植的患者的翻修风险在统计学上显著降低。
Background: A number of studies have found comparable results after anterior cruciate ligament (ACL) reconstruction with patellar tendon autografts and hamstring autografts; however, few studies have been large enough to reveal differences in risk of revision with regard to clinical and demographic factors. Purpose: To present the distribution of grafts for ACL reconstruction based on data in the Scandinavian ACL registries and to compare the risk of revision between patellar tendon autografts and hamstring autografts. Potential associations with other clinical and demographic factors were also explored. Study design: Cohort study; Level of evidence, 2. Methods: A total of 45,998 primary ACL reconstructions, including 6736 patellar tendon autografts and 38,666 hamstring autografts, were identified in the Scandinavian ACL registries. The overall median follow-up time was 3 years (range, 0-8 years). To compare the risk of revision between groups of patients, univariate Kaplan-Meier analysis (with log-rank test) and the Cox proportional hazard regression model were applied. The hazard rate ratio with 95% CI was reported as a measure of effect. Results: Patellar tendon and hamstring autografts were used in 14.6% and 84.1% of the patients, respectively. The remaining patients received allografts, direct sutures, or other graft types (1.3%). The primary ACL injury occurred during soccer, team handball, or alpine activities in 67.5% of the patients in the patellar tendon group and 66.2% in the hamstring group. A total of 156 patients in the patellar tendon group and 1042 patients in the hamstring group underwent revision. The overall risk of revision was significantly lower in the patellar tendon group versus the hamstring group (hazard rate ratio = 0.63; 95% CI, 0.53-0.74), and it decreased with increasing age at surgery, although not strictly linearly. The lower risk of revision in the patellar tendon group was consistently observed across subgroups of patient sex, age, and concomitant cartilage injury (P > .05, test for interaction) but seemed to be slightly more pronounced for patients injured during certain pivoting activities (soccer, team handball, and alpine activities) compared with other activities (hazard rate ratio = 0.57 vs 0.81; P = .058, test for interaction). Conclusion: The majority of primary ACL reconstructions in Scandinavia are performed with hamstring autografts. Results from the present large prospective study show that patients receiving patellar tendon autografts have a statistically significantly lower risk of revision compared with patients receiving hamstring autografts.
DOI：
10.1016/j.arthro.2013.08.025
发表时间：
2013-12
影响因子：
4.7
作者：
Mariscalco, Michael W.;Flanigan, David C.;Mitchell, Joshua;Pedroza, Angela D.;Jones, Morgan H.;Andrish, Jack T.;Parker, Richard D.;Kaeding, Christopher C.;Magnussen, Robert A.
通讯作者：
Magnussen, Robert A.
影响因子：
3.8
作者：
Magnussen, Robert A.;Carey, James L.;Spindler, Kurt P.
通讯作者：
Spindler, Kurt P.