The effect of initial graft tension after anterior cruciate ligament reconstruction: a randomized clinical trial with 36-month follow-up.
The effect of initial graft tension after anterior cruciate ligament reconstruction: a randomized clinical trial with 36-month follow-up.
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DOI：
10.1177/0363546512464200
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发表时间：
2013-01
期刊：
影响因子：
--
通讯作者：
Tung GA
中科院分区：
文献类型：
--
作者：
Fleming BC;Fadale PD;Hulstyn MJ;Shalvoy RM;Oksendahl HL;Badger GJ;Tung GA
在前交叉韧带（ACL）重建时施加的初始移植物张力改变了关节接触，并可能影响软骨健康。目的是比较两种常用的“基于松弛度”的初始移植物张力方案之间的结局。我们假设，1）在36个月的愈合后，高张力组的膝关节松弛度更小，临床和患者导向的结局得到改善，软骨损伤比低张力组更少，2）高张力组的结局与匹配的对照组相当。随机对照临床试验。90例孤立性单侧ACL损伤患者随机接受ACL重建，使用两种初始移植物张力方案之一：1）在手术时拉紧自体移植物以恢复正常的前后（AP）松弛（即，“低张力”; n=46）和2）自体移植物张紧以过度限制AP松弛2 mm（即，“高张力”; n=44）。对照组为60例健康志愿者。在术前、术中以及术后6个月、12个月和36个月评估结局。在36个月时，两种初始移植物张力方案的任何结局指标均无显著差异。然而，两个治疗组与对照组相比存在差异。平均而言，ACL重建组的AP松弛度比对照组大2 mm（p<0.007）。IKDC膝关节评估评分（p<0.001）、峰值等速膝关节伸展扭矩（p<0.027）和5项膝关节骨关节炎结局评分中的4项（KOOS; p<0.05）均显著差于对照组。36个月时，两组的SF-36评分和再损伤率相似。尽管两个治疗组的ACL重建膝关节存在显著的影像学和MRI变化，但幅度相对较小，在36个月时可能无临床意义。与对照组相比，两种基于松弛度的初始移植物张力方案产生了相似的结局，但未完全恢复关节功能和KOOS评分。手术后36个月，软骨损伤的证据很少。
The initial graft tension applied at the time of anterior cruciate ligament (ACL) reconstruction alters joint contact and may influence cartilage health. The objective was to compare outcomes between two commonly used “laxity-based” initial graft tension protocols. We hypothesized that; 1) the high-tension group would have less knee laxity, improved clinical and patient-oriented outcomes, and less cartilage damage than the low-tension group after 36-months of healing, and 2) the outcomes of the high-tension group would be equivalent to those of a matched control group. Randomized controlled clinical trial. Ninety patients with isolated unilateral ACL injuries were randomized to undergo ACL reconstruction using one of two initial graft tension protocols; 1) autografts tensioned to restore normal anteroposterior (AP) laxity at the time of surgery (i.e., “low-tension”; n=46) and 2) autografts tensioned to over-constrain AP laxity by 2 mm (i.e., “high-tension”; n=44). Sixty matched healthy subjects formed the control group. Outcomes were assessed pre-operatively, intra-operatively, and at 6-, 12- and 36-months after surgery. No significant differences were found between the two initial graft tension protocols for any of the outcome measures at 36-months. However, there were differences when comparing the two treatment groups to the control group. On average, AP laxity was 2 mm greater in the ACL reconstructed groups than in the control group (p<.007). IKDC knee evaluation scores (p<0.001), peak isokinetic knee extension torques (p<.027), and 4 out of 5 of the Knee Osteoarthritis Outcome Scores (KOOS; p<.05) were significantly worse than the control group. SF-36 scores and re-injury rates were similar between groups at 36-months. Although there were significant radiographic and MRI changes present in the ACL reconstructed knees of both treatment groups, the magnitude was relatively small and likely clinically insignificant at 36-months. Both laxity-based initial graft tension protocols produced similar outcomes without fully restoring joint function and KOOS scores when compared to the control group. There was minimal evidence of cartilage damage 36-months after surgery.
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影响因子：
4.8
作者：
Nicholas, SJ;D'Amato, MJ;McHugh, MR
通讯作者：
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DOI：
10.2106/00004623-200206000-00003
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