Graft Size and Patient Age Are Predictors of Early Revision After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft
Graft Size and Patient Age Are Predictors of Early Revision After Anterior Cruciate Ligament Reconstruction With Hamstring Autograft
复制标题
DOI：
10.1016/j.arthro.2011.11.024
复制
发表时间：
2012-04-01
影响因子：
4.7
通讯作者：
Garrett, William E.
中科院分区：
文献类型：
--
作者：
Magnussen, Robert A.;Lawrence, J. Todd R.;Garrett, William E.
目的：评价自体腘绳肌移植物尺寸减小和患者年龄降低是否是早期移植物翻修的预测因素。研究方法：在338例接受自体腘绳肌移植物初次前交叉韧带（ACL）重建的连续患者中，对256例（75.7%）进行了评价。记录ACL重建时的移植物尺寸和患者年龄、性别和体重指数，沿着随后是否进行ACL翻修。结果：256例患者中，男性136例，女性120例，年龄11 ~ 52岁（平均25.0岁）。平均随访14个月（范围：6 - 47个月）。256例患者中有18例（7.0%）在术后平均12个月（范围：3 - 31个月）进行了ACL翻修重建。移植物直径大于8 mm的58例患者中有1例（1.7%）进行了翻修，移植物直径为7.5或8 mm的139例患者中有9例（6.5%）进行了翻修，移植物直径为7 mm或更小的59例患者中有8例（13.6%）进行了翻修（P = 0.027）。137例20岁或以上患者（0.7%）进行了1次翻修，但119例20岁以下患者（14.3%）进行了17次翻修（P < .0001）。大多数翻修术（18例中的16例）发生在年龄在20岁以下、移植物直径为8 mm或更小的患者中，该人群的翻修率为16.4%（97例患者中的16例）。重建时年龄小于20岁（比值比[OR]，18.97; 95%置信区间[CI]，2.43 - 147.06; P = .005），移植物尺寸减小（OR，2.20; 95% CI，1.00 - 4.85; P = 0.05）和随访时间增加（OR，1.07; 95% CI，1.02 - 1.12）与翻修风险增加相关。结论：自体腘绳肌移植物尺寸减小和患者年龄降低是早期移植物翻修的预测因素。在20岁以下患者中使用直径小于或等于8 mm的腘绳肌自体移植物与较高的翻修率相关。证据等级：III级，回顾性比较研究。
Purpose: To evaluate whether decreased hamstring autograft size and decreased patient age are predictors of early graft revision. Methods: Of 338 consecutive patients undergoing primary anterior cruciate ligament (ACL) reconstruction with hamstring autograft, 256 (75.7%) were evaluated. Graft size and patient age, gender, and body mass index at the time of ACL reconstruction were recorded, along with whether subsequent ACL revision was performed. Results: The 256 patients comprised 136 male and 120 female patients and ranged in age from 11 to 52 years (mean, 25.0 years). The mean follow-up was 14 months (range, 6 to 47 months). Revision ACL reconstruction was performed in 18 of 256 patients (7.0%) at a mean of 12 months after surgery (range, 3 to 31 months). Revision was performed in 1 of 58 patients (1.7%) with grafts greater than 8 mm in diameter, 9 of 139 patients (6.5%) with 7.5- or 8-mm-diameter grafts, and 8 of 59 patients (13.6%) with grafts 7 mm or less in diameter (P = .027). There was 1 revision performed in the 137 patients aged 20 years or older (0.7%), but 17 revisions were performed in the 119 patients aged under 20 years (14.3%) (P < .0001). Most revisions (16 of 18) were noted to occur in patients aged under 20 years with grafts 8 mm in diameter or less, and the revision rate in this population was 16.4% (16 of 97 patients). Age less than 20 years at reconstruction (odds ratio [OR], 18.97; 95% confidence interval [CI], 2.43 to 147.06; P = .005), decreased graft size (OR, 2.20; 95% CI, 1.00 to 4.85; P = .05), and increased follow-up time (OR, 1.07; 95% CI, 1.02 to 1.12) were associated with increased risk of revision. Conclusions: Decreased hamstring autograft size and decreased patient age are predictors of early graft revision. Use of hamstring autografts 8 mm in diameter or less in patients aged under 20 years is associated with higher revision rates. Level of Evidence: Level III, retrospective comparative study.