Anterior cruciate ligament replacement: Comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts - A prospective, randomized study
Anterior cruciate ligament replacement: Comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts - A prospective, randomized study
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DOI：
10.2106/00004623-200209000-00001
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发表时间：
2002-09-01
影响因子：
5.3
通讯作者：
Renstrom, P
中科院分区：
文献类型：
--
作者：
Beynnon, BD;Johnson, RJ;Renstrom, P
背景本研究的目的是评价用骨-髌腱-骨自体移植物或双股半腱肌-股薄肌自体移植物置换撕裂的前交叉韧带，以比较临床测试结果、患者满意度、活动水平、功能状态和肌肉力量。方法.五十六例前交叉韧带撕裂的患者参加了一项前瞻性、随机、对照研究。其中二十八例接受了骨-髌腱-骨自体移植重建，二十八例接受了双股半腱肌-股薄肌自体移植治疗。（范围，36至57个月）在最终随访时，对每组22名患者的临床试验结果、患者满意度、活动水平、功能状态和等速肌力进行评价。结果骨-髌腱-骨移植物置换前交叉韧带的客观疗效上级双股半腱肌-股薄肌移植物。随访3年，使用腘绳肌移植物的患者膝关节前松弛度比对侧正常膝关节平均增加4.4mm，而使用骨-髌腱-骨移植物的患者膝关节松弛度平均增加11 mm。22名使用腘绳肌移植物的患者中有14%（3名）有轻微的枢轴移位，27%（6例）有中度枢轴移位。22例骨-髌腱-骨移植患者中只有14%（3例）有轻度枢轴移位，在相同的随访时间内，使用腘绳肌移植物的患者的峰值膝关节屈曲强度明显低于使用骨-髌腱-骨移植物的患者。（p = 0 039）相比之下，两种治疗方法在患者满意度、活动水平和膝关节功能（单腿跳跃、负重、下蹲、爬楼梯、原地跑步和鸭子行走的能力）方面产生了相似的结果。结论. 3年随访后，在膝关节松弛度、膝关节移位等级和膝屈肌强度方面，采用自体骨-髌腱-骨移植物进行前交叉韧带置换的客观结果上级采用双股半腱肌-股薄肌移植物进行置换的客观结果。但是，两组在患者满意度、活动水平和膝关节功能方面具有可比性。
Background. The purpose of this investigation was to evaluate replacement of a torn anterior cruciate ligament with either a bone-patellar tendon-bone autograft or a two-strand semitendinosus-gracilis autograft to compare the results of clinical testing, patient satisfaction, activity level, functional status, and muscle strength. Methods. Fifty-six patients with a torn anterior cruciate ligament were enrolled in a prospective, randomized, controlled study Twenty-eight underwent reconstruction with a bone-patellar tendon-bone autograft, and twenty-eight were treated with a two-strand semitendinosus-gracilis autograft Patients were followed for an average of thirty-nine months (range, thirty-six to fifty-seven months) At the time of final follow-up, twenty-two patients in each group were evaluated in terms of clinical test findings, patient satisfaction, activity level, functional status, and isokinetic muscle strength. Results The objective outcome of replacement of the torn anterior cruciate ligament with a bone-patellar tendon-bone graft was superior to that obtained with a two-strand semitendinosus-gracilis graft At the three-year follow-up interval, the patients in whom a hamstring graft had been used had an average of 4 4 mm of increased anterior knee laxity compared with the laxity of the contralateral, normal knee, whereas the patients in whom a bone-patellar tendon-bone graft had been used had an average of 11 mm of increased knee laxity Fourteen percent (three) of the twenty-two patients with a hamstring graft had a mild pivot shift, and 27% (six) had a moderate pivot shift Only 14% (three) of the twenty-two patients with a bone-patellar tendon-bone graft had a mild pivot shift, and none had a moderate pivot shift At the same follow-up interval, the patients in whom a hamstring graft had been used had significantly lower peak knee-flexion strength than those who had a bone-patellar tendon-bone graft (p = 0 039) In contrast, the two treatments produced similar outcomes in terms of patient satisfaction, activity level, and knee function (ability to perform a one-legged hop, bear weight, squat, climb stairs, run in place, and duckwalk). Conclusions. After three years of follow-up, the objective results of anterior cruciate ligament replacement with a bone-patellar tendon-bone autograft were superior to those of replacement with a two-strand semitendinosus-gracilis graft with regard to knee laxity, pivot-shift grade, and strength of the knee flexor muscles However, the two groups had comparable results in terms of patient satisfaction, activity level, and knee function.