改良髂胫束-同种异体移植物技术用于前交叉韧带翻修联合外侧关节外手术的疗效与骨-髌腱-骨联合改良Lemaire术相当
简介
本研究比较了翻修前交叉韧带重建术（R-ACLR）中两种术式的临床疗效：改良髂胫束-同种异体移植物（ITB-AG）技术（同时完成外侧关节外手术）与骨-髌腱-骨联合Lemaire外侧加强（BPTB-LET）。共纳入195例患者（BPTB-LET组105例，ITB-AG组90例），平均随访3年左右。关键发现：两组移植物再撕裂率无显著差异（5.7% vs 4.4%）…
英文摘要
PURPOSE: In revision anterior cruciate ligament reconstruction (R-ACLR), adding a lateral extra-articular procedure (LEAP) reduces graft failure and postoperative laxity. Iliotibial band (ITB)-based techniques may avoid patellar tendon harvesting morbidity, but evidence in adults, particularly in revision cases, remains limited. We compared clinical outcomes at ≥2 years after R-ACLR using a modified ITB-allograft (ITB-AG) technique versus bone-patellar tendon-bone with lateral extra-articular tenodesis (BPTB-LET). It was hypothesized that no difference in retear rates between techniques would be found. METHODS: A retrospective analysis of prospectively collected data was performed on consecutive adult patients (≥18 years) undergoing R-ACLR between 2018 and 2023. Patients were included if they received ITB-AG or BPTB-LET R-ACLR, if surgery occurred within 24 months of graft failure and follow-up was ≥2 years. Exclusions were multiligament injury, concomitant osteotomy or refusal to participate. Primary outcome was graft retear, and secondary outcomes were International Knee Documentation Committee (IKDC) subjective score, Lysholm score, complications, side-to-side anterior laxity and pivot-shift grade. Comparisons between groups were performed using Student's t test or Mann-Whitney U test for continuous variables and chi-square or Fisher exact test for categorical variables, with statistical significance set at p < 0.05. RESULTS: One hundred ninety-five patients were analysed (BPTB-LET, n = 105; ITB-AG, n = 90). Groups were similar at baseline; follow-up was 38 ± 9 months for BPTB-LET and 34 ± 7 months for ITB-AG (p = 0.0005). Meniscal tears and repairs were more frequent with ITB-AG; graft diameter was slightly smaller with ITB-AG (8.8 ± 0.7 mm for ITB-AG vs. 9.3 ± 0.5 mm for BPTB-LET; p = 0.0001). Retear rates were not different (5.7% BPTB-LET vs. 4.4% ITB-AG; p = 0.7551). IKDC was higher with ITB-AG (90.7 ± 10.8 vs. 88.3 ± 10.1; p = 0.0026); 97% (BPTB-LET) and 93% (ITB-AG) achieved the IKDC Patient Acceptable Symptom State (p = 0.3073). Lysholm was higher with ITB-AG (94.6 ± 10.8 vs. 90.8 ± 9.0; p < 0.00001). A negative pivot-shift was found in 98.9% (ITB-AG) versus 66.7% (BPTB-LET) (p < 0.00001), while KT-1000 anterior laxity did not differ significantly (p = 0.1164). Complication rates were similar (4.7% vs. 5.5%; p = 1). CONCLUSION: At midterm follow-up, a modified ITB-AG technique provided comparable graft survival to BPTB-LET, with similarly low complication rates. Patient-reported outcome measures were statistically higher and a greater proportion of patients demonstrated a negative pivot-shift test in the ITB-AG group, although the clinical relevance of these differences remains uncertain. LEVEL OF EVIDENCE: Level III.