前交叉韧带重建采用股直肌、股四头肌腱与腘绳肌自体移植物后股四头肌力量恢复相似
简介
一项前瞻性队列研究纳入90例ACL重建患者，比较股直肌、股四头肌腱与腘绳肌腱自体移植物术后12个月的股四头肌力量恢复。结果显示，三组等速肌力测试的股四头肌峰值力矩肢体对称指数无显著差异，股直肌移植物在预设非劣效界值内不劣于其他两种移植物。该结果提示，在中期随访中，股直肌自体移植物不会导致更差的伸膝功能恢复，为移植物选择提供了新的参考依据。
英文摘要
PURPOSE: Persistent quadriceps weakness remains a major concern following anterior cruciate ligament reconstruction (ACLR), and graft harvest site may influence postoperative strength recovery. The purpose of this study was to compare quadriceps strength recovery at 12 months following ACLR using rectus femoris (RF), quadriceps tendon (QT), or hamstring (HS) autografts. We hypothesised that RF reconstruction would demonstrate quadriceps recovery that is non-inferior to QT and HS autografts. METHODS: A prospective comparative cohort study was conducted, including 90 patients undergoing primary ACLR (30 RF, 30 QT and 30 HS). Isokinetic assessment was performed at 12 months. The primary outcome was quadriceps peak torque limb symmetry index (LSI) at 60°/s. A non-inferiority margin of 10% points was predefined. Outcomes were analysed using analysis of covariance adjusted for age, body mass index and sex. Estimated marginal means (EMMs) and 95% confidence intervals (CIs) were calculated. RESULTS: Adjusted EMMs for quadriceps peak torque LSI at 60°/s were 81.4% (95% CI 73.2-89.6) for RF, 73.4% (95% CI 65.2-81.6) for QT and 71.5% (95% CI 63.2-79.7) for HS. No differences between groups were detected (p = 0.204). Pairwise adjusted differences were 7.9% for RF versus QT (95% CI -6.3 to 22.2; p = 0.529) and 9.9% for RF versus HS (95% CI -4.3 to 24.1; p = 0.280). Under the predefined non-inferiority margin, RF was non-inferior to both QT and HS autografts. No significant differences were observed for secondary isokinetic parameters or hamstring-to-quadriceps ratios. CONCLUSION: At 12 months following ACL reconstruction, quadriceps strength recovery after RF autograft was similar to that observed after QT or HS grafts. When evaluated within a clinically relevant non-inferiority framework and adjusted for biological covariates, ACLR with RF autograft does not appear to yield worse extensor performance at mid-term follow-up relative to other common graft types. LEVEL OF EVIDENCE: Level II.