足球运动员前交叉韧带重建：一项基于瑞典全国登记系统的前内侧与经胫骨股骨隧道技术比较研究
简介
基于瑞典全国注册数据库，本研究纳入7,169名足球运动员（AM组6,653例，TT组516例），比较前内侧入路（AM）与经胫骨隧道（TT）两种股骨隧道技术用于前交叉韧带重建（ACLR）的临床结局。关键发现：两组重返比赛率（55.2% vs. 56.8%）、重返时间、比赛出场次数、赛季数及伤前伤后竞技水平均无显著差异；患者报告结局（PROMs）在1年时AM组略…
英文摘要
PURPOSE: To compare anteromedial (AM) portal versus transtibial (TT) femoral drilling techniques in football players undergoing anterior cruciate ligament reconstruction (ACLR), focusing on return-to-competition (RTC), match exposure, patient-reported outcomes (PROMs) and reinjury risk. METHODS: This nationwide cohort study linked the Swedish Knee Ligament Registry with the Swedish Football Association to capture surgical details, verified football participation, and longitudinal PROMs. All index ACLRs in registered football players from 2017-2023 were included. Outcomes were RTC, match exposure, Knee injury and Osteoarthritis Outcome Score and EuroQol 5 dimension score scores at pre-op, 1, 2 and 5 years, and revision, contralateral, or any second ACL reconstruction. Analyses used t-tests and χ 2 tests, and Cox regression adjusted for age, sex, injured side, and meniscal and cartilage injury. RESULTS: A total of 7169 football players were included (AM 6,653; TT 516). Group differences at baseline were small but present (e.g., more women and left-sided injuries in TT; more meniscal repair and cartilage injury in AM). RTC rates were similar (55.2% AM vs. 56.8% TT), as were time to RTC, total matches played, matches after RTC, seasons played, and competitive level before and after injury. PROMs showed modest 1-year differences favouring AM that were not observed at 2 years. No differences were observed at 5 years, although based on limited TT data. Reinjury rates were comparable (revision 6.7% AM vs. 7.4% TT; contralateral 4.6% vs. 4.8%; any second ACLR 11.0% vs. 11.8%). Adjusted Cox models showed no association between portal technique and revision (hazard ratio [HR] 0.878, 95% confidence interval [CI] 0.63-1.23) or any second ACLR (HR 0.906, 95% CI 0.70-1.18), with similar findings in RTC-only analyses. CONCLUSION: In a nationwide cohort of football players, AM and TT femoral drilling techniques yielded similar real-world outcomes: comparable reinjury risk, RTC rates and timing, match exposure, competitive trajectory, and PROMs. For football players undergoing primary ACL reconstruction, both AM and TT techniques are acceptable options. LEVEL OF EVIDENCE: Level III, retrospective cohort study.