自体腘绳肌腱与骨-髌腱-骨移植物前交叉韧带重建术后疗效相似但供区并发症谱显著不同
简介
本研究比较了股四头肌腱（QT）与骨-髌腱-骨（BPTB）自体移植物在ACL重建术后2年的供区病损差异。共纳入50例QT患者（平均年龄22.6岁）和88例BPTB患者（平均年龄22.8岁），平均随访31.1个月。结果显示：两组总供区病损评分无显著差异（87.2 vs 84.2，P=0.343），但BPTB组股四头肌萎缩更轻，而QT组供区疼痛、麻木及跪地痛更少。…
英文摘要
PURPOSE: To compare differences in donor site morbidity (DSM) following quadriceps tendon (QT) autograft and bone-patellar tendon-bone (BPTB) autograft anterior cruciate ligament reconstruction (ACLR) at 2 year follow-up. METHODS: Patients who underwent primary ACLR with QT autograft between January 2018 and February 2020 were identified in a single institution registry and matched on the basis of age and sex to a control group of BPTB autograft ACLR patients. Patients were contacted at a minimum of 2 years postsurgery to evaluate DSM, Patient Reported Outcome Measures (PROMs), Return to Sport (RTS), and reoperation. RESULTS: Fifty QT patients (mean age 22.6 years) and 88 BPTB patients (mean age 22.8 years) were included (mean follow-up 31.1 months; range 24.1-56.2). Total DSM score was similar between QT and BPTB patients (87.2 vs 84.2, P = .343); however, BPTB patients exhibited less quadriceps wasting/atrophy, but QT patients had less pain at the donor site, numbness, and pain with kneeling. Female sex was an independent predictor of inferior DSM score (Estimate: -6.4, P = .04), and quadriceps wasting/atrophy was worse in female QT than BPTB patients (Estimate: -2.90, P < .0001). There were no significant differences between QT and BPTB patients in PROMs. 87% of QT patients and 74% of BPTB patients returned to sports (P = .093). There was a higher rate of ipsilateral reoperation in the QT group compared with the BPTB group (26% vs 10%, P = .016), but no differences in reoperation for ipsilateral graft failure or contralateral ACL rupture between groups. CONCLUSIONS: Our findings suggest that overall, the QT autograft was associated with significantly less donor site pain, numbness, and pain with kneeling, but more quadriceps wasting/atrophy than BPTB autografts in patients undergoing primary ACLR. These distinct DSM profiles, along with observed differences in quadriceps wasting/atrophy between sexes, should guide patient education accordingly. LEVEL OF EVIDENCE: Level III, retrospective comparative case series.