Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction A Prospective Randomized Study With 10-Year Results
Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction A Prospective Randomized Study With 10-Year Results
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DOI：
10.1177/0363546517712231
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发表时间：
2017-09-01
影响因子：
4.8
通讯作者：
Jarvela, Timo
中科院分区：
文献类型：
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作者：
Jarvela, Sally;Kiekara, Tommi;Jarvela, Timo
背景：双束和单束技术用于前交叉韧带（ACL）重建的长期随访比较尚未见报道。假设：与单束重建相比，双束前交叉韧带重建可能具有更少的移植物破裂，更低的骨关节炎（OA）发生率和更好的稳定性。研究设计：随机对照试验；证据等级2。方法：90例患者随机分为生物可吸收螺钉固定双束ACL重建（DB组，n = 30）、生物可吸收螺钉固定单束ACL重建（SBB组，n = 30）和金属螺钉固定单束ACL重建（SBM组，n = 30）。评估方法包括临床检查，KT-1000关节计测量，国际膝关节文献委员会（IKDC）和Lysholm膝关节评分，以及手术和对侧膝关节的x线检查。结果：在10年随访中，81例患者（90%）可获得。11例患者（DB组1例，SBB组7例，SBM组3例）在随访期间发生移植物失败，并继续进行ACL翻修手术（P = 0.043）。在剩余的70例患者中，在10年内，枢轴移位试验结果、KT-1000关节计测量或膝关节评分没有发现显著的组间差异。OA主要发生在膝关节内侧腔室，38%的患者发生在手术膝关节，28%的患者发生在对侧未手术膝关节。但组间无明显差异。最严重的OA变化发生在从原发损伤到ACL重建延迟时间最长的患者（P = 0.047）和在ACL重建时进行部分半月板切除术的患者（P = 0.024）。结论：在随访中，双束ACL重建的移植失败明显少于单束ACL重建。10年时，膝关节稳定性和OA率相似。从原发损伤到ACL重建的延迟时间最长的患者以及在ACL重建时进行部分半月板切除术的患者中发现了最严重的OA变化。
Background: A long-term follow-up comparing double-bundle and single-bundle techniques for anterior cruciate ligament (ACL) reconstruction has not been reported before.Hypothesis: Double-bundle ACL reconstruction may have fewer graft ruptures, lower rates of osteoarthritis (OA), and better stability than single-bundle reconstruction.Study Design: Randomized controlled trial; Level of evidence, 2.Methods: Ninety patients were randomized for double-bundle ACL reconstruction with bioabsorbable screw fixation (DB group; n = 30), single-bundle ACL reconstruction with bioabsorbable screw fixation (SBB group; n = 30), and single-bundle ACL reconstruction with metallic screw fixation (SBM group; n = 30). Evaluation methods consisted of a clinical examination, KT-1000 arthrometer measurements, International Knee Documentation Committee (IKDC) and Lysholm knee scores, and a radiographic examination of both the operated and contralateral knees.Results: Eighty-one patients (90%) were available at the 10-year follow-up. Eleven patients (1 in the DB group, 7 in the SBB group, and 3 in the SBM group) had a graft failure during the follow-up and went on to undergo revision ACL surgery (P = .043). In the remaining 70 patients at 10 years, no significant group differences were found in the pivot-shift test findings, KT-1000 arthrometer measurements, or knee scores. The most OA findings were found in the medial compartment of the knee, with 38% of the patients in the operated knee and 28% of the patients in the contralateral nonoperated knee. However, no significant group difference was found. The most severe OA changes were in the patients who had the longest delay from the primary injury to ACL reconstruction (P = .047) and in the patients who underwent partial meniscal resection at the time of ACL reconstruction (P = .024).Conclusion: Double-bundle ACL reconstruction resulted in significantly fewer graft failures than single-bundle ACL reconstruction during the follow-up. Knee stability and OA rates were similar at 10 years. The most severe OA changes were found in the patients who had the longest delay from the primary injury to ACL reconstruction and in the patients who underwent partial meniscal resection at the time of ACL reconstruction.