A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction - Patellar tendon versus semitendinosus and gracilis tendon graft
A 6-year follow-up of the effect of graft site on strength, stability, range of motion, function, and joint degeneration after anterior cruciate ligament reconstruction - Patellar tendon versus semitendinosus and gracilis tendon graft
复制标题
DOI：
10.1177/0363546506298277
复制
发表时间：
2007-05-01
影响因子：
4.8
通讯作者：
Bullock, Margaret I.
中科院分区：
文献类型：
--
作者：
Keays, Susan L.;Bullock-Saxton, Joanne E.;Bullock, Margaret I.
背景：前交叉韧带重建中移植物材料的选择一直存在争议。尽管需要对髌骨肌腱和腿筋移植进行对照的长期结果研究，但很少有研究跟踪结果超过5年。假设：移植物来源不会影响重建后6年的预后。研究设计：队列研究；证据等级2。方法：对62例前交叉韧带重建术患者和18例未损伤对照进行6年的研究。31例患者接受髌骨手术。31例接受腘绳肌腱移植。评估包括膝关节稳定性、活动范围、肌肉力量、主观功能、客观功能（跑步、回避、carioca和跳跃测试）和关节退变。结果：除2例腘绳肌移植受者再损伤外，其余患者均恢复了临床稳定。髌骨肌腱组（1.9 mm）和腘绳肌腱组（2.0 mm）的KT-1000关节计侧侧向差异相似，但显著大于未损伤对照组（P < 0.001）。尽管髌骨肌腱移植术后存在6%的股四头肌缺损，但手术组和对照组之间的肌力没有显著差异。在更苛刻的功能测试（跳跃和三跳指数和carioca）中，腿筋移植受体的表现与对照组相似，而髌骨肌腱移植组与对照组之间存在显著差异（P < 0.05）。髌骨肌腱重建术后早期胫股骨关节炎的发生率（62%）明显高于腘绳肌腱移植术后（33%;P = 0.002）。结论：不论移植来源如何，6年的治疗效果都非常满意。然而，使用腘绳肌腱重建可以改善功能表现，降低骨关节炎的发病率。
Background: The choice of graft material for anterior cruciate ligament reconstruction remains controversial. Despite the need for well-controlled, long-term outcome studies comparing patellar tendon with hamstring grafting, few studies have followed results for more than 5 years.Hypothesis: Graft source will not affect outcome 6 years after reconstruction.Study Design: Cohort study; Level of evidence, 2.Methods: Sixty-two patients with anterior cruciate ligament reconstruction and 18 uninjured control subjects were studied over 6 years. Thirty-one patients received patellar. tendon grafts, and 31 received hamstring tendon grafts. Assessment included knee joint stability, range of motion, muscle strength, subjective function, objective function (running, sidestepping, carioca, and hop tests), and joint degeneration.Results: Clinical stability was restored to all patients other than to the 2 hamstring graft recipients who suffered reinjuries. The KT-1000 arthrometer side-to-side differences were similar in the patellar tendon (1.9 mm) and hamstring tendon (2.0 mm) groups but were significantly greater than that of uninjured control subjects (P < .001). There were no significant strength differences between surgical and control groups, although a 6% quadriceps deficit existed after patellar tendon grafting. In the more demanding functional tests (hop and triple-hop indices and carioca), the hamstring graft recipients performed similarly to the control group, whereas a significant difference (P < .05) existed between the patellar tendon graft and the control group. The incidence of early tibiofemoral osteoarthritis was significantly greater after reconstruction using patellar tendon (62%) than after hamstring tendon grafting (33%; P = .002).Conclusion: Six-year outcomes were very satisfactory irrespective of graft source. However, reconstruction using the hamstring tendons resulted in improved functional performance and a lower incidence of osteoarthritis.