Activity Level and Graft Type as Risk Factors for Anterior Cruciate Ligament Graft Failure A Case-Control Study
Activity Level and Graft Type as Risk Factors for Anterior Cruciate Ligament Graft Failure A Case-Control Study
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活动量和移植物类型是前十字韧带移植物失败的风险因素 一项病例对照研究
DOI：
10.1177/0363546509340633
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发表时间：
2009-12-01
影响因子：
4.8
通讯作者：
Kaeding, Christopher
中科院分区：
文献类型：
--
作者：
Borchers, James R.;Pedroza, Angela;Kaeding, Christopher
背景：前交叉韧带 (ACL) 移植物衰竭是重建后罕见但具有破坏性的事件，移植物失败的危险因素尚不清楚。假设：ACL 重建后恢复到高活动水平和使用同种异体移植物是 ACL 移植物失败的危险因素。证据级别，3。方法：在 2 年期间确定了 21 名 ACL 移植失败患者。在同一时期确定了 42 名年龄和性别匹配的对照。采用1:2匹配的病例对照设计来评估重建后的活动水平和移植物类型作为ACL移植物失败的危险因素。使用逻辑回归分析来确定重建后的活动水平以及病例和对照之间的移植物类型的比值比。比较特定层的比值比，评估重建后的活动水平和移植物类型之间的关联（相互作用）。结果：单变量逻辑回归模型显示，与低活动水平相比，高活动水平的患者 ACL 移植失败的几率增加（比值比 [OR]，5.53；95% 置信区间 [CI]，1.18-28.61；P = .03），同种异体移植物与自体移植物相比，ACL 移植失败的几率增加（OR， 5.56；95% CI 1.55-19.98；P = .009）。双变量逻辑回归模型显示，与自体移植相比，同种异体移植的活动水平比值比变化了 35%（OR，4.33；95% CI，0.89-21.16；P = .07），同种异体移植的比值比变化了 13%（OR，4.93；95% CI，1.34-18.20；P = .02）。活动水平和移植物类型之间的特定层比值比显示，较高的活动水平与同种异体移植物之间存在乘法相互作用，导致 ACL 移植失败的可能性更大。结论：重建后较高的活动水平和使用同种异体移植物进行重建是 ACL 移植失败的危险因素。特定层比值比显示 ACL 重建后较高的活动水平与同种异体移植物使用之间存在乘法相互作用，大大增加了 ACL 移植物失败的几率。
Background: Anterior cruciate ligament (ACL) graft failure is an uncommon but devastating event after reconstruction, and risk factors for graft failure are not well understood.Hypothesis: Returning to a high activity level after ACL reconstruction and use of an allograft are risk factors for ACL graft failure.Study Design: Case-control study; Level of evidence, 3.Methods: Twenty-one patients with ACL graft failure were identified over a 2-year period. Forty-two age- and sex-matched controls were identified over the same period. A 1: 2 matched case-control design was used to evaluate activity level after reconstruction and graft type as risk factors for ACL graft failure. Logistic regression analysis was used to determine odds ratios for activity level after reconstruction and for graft type among cases and controls. Association (interaction) between activity level after reconstruction and graft type was evaluated comparing stratum-specific odds ratios.Results: Univariate logistic regression models showed an increased odds of ACL graft failure for those with high activity level compared with low activity level (odds ratio [OR], 5.53; 95% confidence interval [CI], 1.18-28.61; P = .03) and for allografts compared with autografts (OR, 5.56; 95% CI 1.55-19.98; P = .009). A bivariate logistic regression model showed a 35% change in the odds ratio for activity level (OR, 4.33; 95% CI, 0.89-21.16; P = .07) and a 13% change in the odds ratio for allograft compared with autograft (OR, 4.93; 95% CI, 1.34-18.20; P = .02). Stratum-specific odds ratios between activity level and graft type show a multiplicative interaction between higher activity level and allograft for much greater odds of ACL graft failure.Conclusion: Higher activity level after reconstruction and allograft use for reconstruction are risk factors for ACL graft failure. Stratum-specific odds ratios show a multiplicative interaction between higher activity level after ACL reconstruction and allograft use, greatly increasing the odds for ACL graft failure.