Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction: Predictors of Failure From a MOON Prospective Longitudinal Cohort.
Allograft Versus Autograft Anterior Cruciate Ligament Reconstruction: Predictors of Failure From a MOON Prospective Longitudinal Cohort.
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DOI：
10.1177/1941738110386185
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发表时间：
2011-01
期刊：
影响因子：
3.3
通讯作者：
Spindler KP
中科院分区：
文献类型：
--
作者：
Kaeding CC;Aros B;Pedroza A;Pifel E;Amendola A;Andrish JT;Dunn WR;Marx RG;McCarty EC;Parker RD;Wright RW;Spindler KP
前十字韧带 (ACL) 移植物撕裂是 ACL 重建 (ACLR) 后发生的灾难性事件。识别和了解 ACLR 移植失败的独立预测因素对于手术计划、患者咨询和降低移植失败风险的努力非常重要。患者和手术变量将预测 ACLR 后的移植失败。前瞻性队列研究。一个多中心小组于 2002 年发起了一项队列研究，以确定 ACLR 结果（包括移植失败）的预测因子。首先，为了控制混杂因素，使用单个外科医生的数据（n = 281 ACLR）开发 ACLR 移植失败的多变量回归模型。评估变量包括移植物类型（自体移植物与同种异体移植物）、性别、年龄、体重指数、指数损伤时的活动、半月板撕裂的存在以及初次重建与翻修重建。其次，使用多中心研究的其余数据（n = 645 ACLR）验证模型，以评估模型的普遍性。对于所有研究外科医生来说，患者年龄和 ACL 移植物类型是移植物失败的重要预测因素。 10至19岁年龄组的患者移植失败的比例最高。同种异体移植重建发生移植物破裂的几率比自体移植重建高 4 倍。年龄每降低 10 岁，移植物破裂的几率就会增加 2.3 倍。接受同种异体移植重建的患者 ACL 移植物破裂的风险增加。年轻患者 ACL 移植失败的风险也增加。考虑到 ACL 移植物破裂的这些风险，在年轻患者群体中进行同种异体移植 ACLR 时应谨慎。
Tearing an anterior cruciate ligament (ACL) graft is a devastating occurrence after ACL reconstruction (ACLR). Identifying and understanding the independent predictors of ACLR graft failure is important for surgical planning, patient counseling, and efforts to decrease the risk of graft failure. Patient and surgical variables will predict graft failure after ACLR. Prospective cohort study. A multicenter group initiated a cohort study in 2002 to identify predictors of ACLR outcomes, including graft failure. First, to control for confounders, a single surgeon’s data (n = 281 ACLRs) were used to develop a multivariable regression model for ACLR graft failure. Evaluated variables were graft type (autograft vs allograft), sex, age, body mass index, activity at index injury, presence of a meniscus tear, and primary versus revision reconstruction. Second, the model was validated with the rest of the multicenter study’s data (n = 645 ACLRs) to evaluate the generalizability of the model. Patient age and ACL graft type were significant predictors of graft failure for all study surgeons. Patients in the age group of 10 to 19 years had the highest percentage of graft failures. The odds of graft rupture with an allograft reconstruction are 4 times higher than those of autograft reconstructions. For each 10-year decrease in age, the odds of graft rupture increase 2.3 times. There is an increased risk of ACL graft rupture in patients who have undergone allograft reconstruction. Younger patients also have an increased risk of ACL graft failure. Given these risks for ACL graft rupture, allograft ACLRs should be performed with caution in the younger patient population.