ACL Repair With Suture Ligament Augmentation Is Associated With a High Failure Rate Among Adolescent Patients
ACL Repair With Suture Ligament Augmentation Is Associated With a High Failure Rate Among Adolescent Patients
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DOI：
10.1177/0363546518825255
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发表时间：
2019-03-01
影响因子：
4.8
通讯作者：
Albright, Jay C.
中科院分区：
文献类型：
--
作者：
Gagliardi, Alexia G.;Carry, Patrick M.;Albright, Jay C.
背景：前交叉韧带（ACL）修复技术避免了移植物收获，因此避免了供体部位发病的风险。然而，使用缝线韧带增强（SLA）进行ACL修复后的早期失败率仍然很高。目的：比较采用SLA进行ACL修复的青少年与采用股四头肌腱-髌骨自体移植物（QPA）进行ACL重建的青少年之间的手术失败、功能结局、恢复运动和关节松弛。研究设计：队列研究;证据等级3。方法：对7-18岁青少年患者采用SLA修复ACL或QPA重建ACL。作者收集了具有术后信息的患者的数据，这些信息与修复的韧带或移植物失败、活动度、并发症以及术后至少6个月恢复运动有关。手术后联系参与者完成研究问卷。结果：该队列包括SLA组的22名连续患者和QPA组的157名连续患者。QPA组的中位随访持续时间为2.7年（四分位距，2.0-3.6年），SLA组为3.2年（2.2-3.4年）。校正性别、年龄、体重指数和受伤至手术时间后，SLA组移植物衰竭的风险是QPA组的10.66倍（95%CI，3.41-32.92; P <0.0001）。SLA组术后前3年内移植物失效的累积发生率为48.8%（95% CI，28.9%-73.1%），而QPA组为4.7%（2.1%-10.3%）。两组之间在恢复运动方面没有差异。在ACL未再断裂的个体中，两组之间的国际膝关节文献委员会和Lysholm评分以及活动度相当。结论：相对于QPA组，SLA组的失败风险显著增加。在选择ACL损伤青少年患者的治疗方法时，应考虑SLA组在短期随访中失败的高风险。
Background: The anterior cruciate ligament (ACL) repair technique avoids graft harvest and therefore the risk of donor site morbidity. However, early failure rates after ACL repair with suture ligament augmentation (SLA) remain high. Purpose: To compare surgical failure, functional outcomes, return to sport, and joint laxity between adolescents who underwent ACL repair with SLA and those who underwent ACL reconstruction with quadriceps tendon-patellar bone autograft (QPA). Study Design: Cohort study; Level of evidence, 3. Methods: Adolescent patients (7-18 years old) underwent ACL repair with SLA or ACL reconstruction with QPA. The authors collected data from those who had postoperative information pertaining to repaired ligament or graft failure, range of motion, complications, and return to sport at a minimum of 6 months after surgery. Participants were contacted after surgery to complete study questionnaires. Results: The cohort included 22 consecutive patients in the SLA group and 157 in the QPA group. The median duration of follow-up was 2.7 years (interquartile range, 2.0-3.6 years) in the QPA group and 3.2 years (2.2-3.4 years) in the SLA group. After adjustment for sex, age, body mass index, and time from injury to surgery, the hazard of graft failure in the SLA group was 10.66 times (95% CI, 3.41-32.92; P < .0001) that of the QPA group. The cumulative incidence of graft failure in the first 3 years after surgery was 48.8% (95% CI, 28.9%-73.1%) in the SLA group, as opposed to 4.7% (2.1%-10.3%) in the QPA group. There was no difference in return to sport between the groups. Among individuals who did not rerupture their ACL, International Knee Documentation Committee and Lysholm scores were comparable between the groups, as well as range of motion. Conclusion: The risk of failure was significantly increased in the SLA group relative to the QPA group. The high risk of failure for the SLA group in this short-term follow-up should be considered when selecting the treatment for adolescent patients with an ACL injury.