20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft The Catastrophic Effect of Age and Posterior Tibial Slope
20-Year Outcomes of Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autograft The Catastrophic Effect of Age and Posterior Tibial Slope
复制标题
DOI：
10.1177/0363546517741497
复制
发表时间：
2018-03-01
影响因子：
4.8
通讯作者：
Pinczewski, Leo A.
中科院分区：
文献类型：
--
作者：
Salmon, Lucy J.;Heath, Emma;Pinczewski, Leo A.
背景：尚无对照良好的研究比较青少年和成人前交叉韧带 (ACL) 重建与自体腘绳肌腱移植的长期结果。据报道，ACL 损伤者与对照组相比，胫骨后斜度 (PTS) 有所增加，但 PTS 对重建后结果的影响相对尚未被探索。目的：比较 20 多年来在青少年和成人队列中使用自体腘绳肌腱进行解剖内镜 ACL 重建治疗“孤立”ACL 断裂的前瞻性纵向结果，并检查重复 ACL 损伤的因素。证据水平，3。方法：对 200 名连续接受独立原发性 ACL 重建和自体腘绳肌腱重建的患者进行了前瞻性研究。受试者在术前以及术后 2 年、7 年、15 年和 20 年时接受评估。结果包括国际膝关节文献委员会 (IKDC) 膝关节评估、IKDC 主观评分、KT 1000 仪器松弛测试以及退行性变化和胫骨内侧坡度的放射学评估。对 18 岁或以下接受手术的患者（青少年组，n = 39）和 18 岁以上接受手术的患者（成人组，n = 161）的 20 年结果进行了比较。 结果：20 岁时，200 名受试者中有 179 名接受了审查（89.5%）。 37 名受试者发生 ACL 移植物断裂，22 名受试者发生对侧 ACL 损伤。在 20 岁时拥有完整 ACL 移植物的患者中，青少年和成人之间的 IKDC 主观评分 (P = .29)、恢复到受伤前活动水平 (P = .84)、当前活动水平 (P = .69) 或 20 岁时放射学退行性改变程度 (P = .51) 等变量的结果没有统计学差异。与成人组相比，青少年组进行 1 级韧带松弛测试的比例较高 (P = .003)。总体而言，成人 ACL 移植物 20 年存活率为 86%，青少年为 61%（风险比，3.3；P = .001）。与成人相比，青少年男性 ACL 移植物断裂的风险增加 4.8 倍，青少年女性增加 2.5 倍。 20 岁时，PTS ≥ 12 度的青少年 ACL 存活率为 22%。与 PTS ≥ 12 度的成年人相比，PTS ≥ 12 度的青少年 ACL 移植物断裂的风险增加了 11 倍 (P = .001)
Background: No well-controlled studies have compared the long-term outcome of anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft between adolescents and adults. Increased posterior tibial slopes (PTSs) have been reported in the ACL-injured versus controls, but the effect of PTS on the outcome after reconstruction is relatively unexplored.Purpose: To compare the prospective longitudinal outcome of "isolated" ACL ruptures treated with anatomic endoscopic ACL reconstruction using hamstring tendon autograft over 20 years in adolescent and adult cohorts and to examine factors for repeat ACL injury.Study Design: Case-control study; Level of evidence, 3.Methods: A single-surgeon series of 200 consecutive patients undergoing isolated primary ACL reconstruction with hamstring tendon autograft were prospectively studied. Subjects were assessed preoperatively and at 2, 7, 15, and 20 years postoperatively. Outcomes included International Knee Documentation Committee (IKDC) Knee Evaluation, IKDC subjective scores, KT 1000 instrumented laxity testing, and radiological evaluation of degenerative change and medial tibial slope. Twenty-year outcomes were compared between those who underwent surgery at the age of 18 years or younger (adolescent group, n = 39) and those who underwent surgery when older than 18 years (adult group, n = 161).Results: At 20 years, 179 of 200 subjects were reviewed (89.5%). ACL graft rupture occurred in 37 subjects and contralateral ACL injury in 22 subjects. Of those with intact ACL grafts at 20 years, outcomes were not statistically different between adolescents and adults for the variables of IKDC subjective score (P = .29), return to preinjury activity level (P = .84), current activity level (P = .69), or degree of radiological degenerative change at 20 years (P = .51). The adolescent group had a higher proportion of grade 1 ligamentous laxity testing compared with the adult group (P = .003). Overall, ACL graft survival at 20 years was 86% for adults and 61% for adolescents (hazard ration, 3.3; P = .001). The hazard for ACL graft rupture was increased by 4.8 in adolescent males and 2.5 in adolescent females compared with adults. At 20 years, the ACL survival for adolescents with a PTS of >= 12 degrees was 22%. The hazard for ACL graft rupture was increased by 11 in adolescents with a PTS of >= 12 degrees (P = .001) cornpared with adults with a PTS