年轻年龄和既往移植物失效是ACL再损伤风险增加的相关因素：初次腘绳肌腱自体移植物重建术后中位10.6年随访的移植物存活率及对侧ACL结果
简介
该研究对415例腘绳肌腱自体移植物ACL重建患者进行中位10.6年随访，发现10年移植物存活率为86.6%，对侧ACL存活率为95.5%。年龄≤21岁使移植物失败风险增加2.62倍，而合并软骨病变反而降低失败风险；初次移植物失败后对侧ACL损伤风险增加3.25倍。提示年轻患者需关注移植物选择与康复策略，并对对侧损伤进行预防。
英文摘要
PURPOSE: To evaluate graft survival and contralateral anterior cruciate ligament (ACL) injury after primary hamstring autograft reconstruction and identify factors associated with these outcomes at a minimum follow-up of 7 years. METHODS: This retrospective cohort study included 415 randomly selected patients who underwent primary single-bundle hamstring tendon ACL reconstruction between 2005 and 2014. Patients were followed for a median of 10.6 years (range, 7.6-17.1). Graft failure was defined as revision reconstruction, clinically or imaging-confirmed rupture or patient-reported characteristic instability in a prespecified worst-case approach. Kaplan-Meier analysis was used to estimate graft survival and contralateral ACL survival. Cox proportional hazards models were used to identify factors associated with graft failure and contralateral injury. Prior graft failure in the index knee was modelled as a time-varying covariate in the contralateral injury analysis. RESULTS: The 10-year graft survival probability was 86.6% (95% confidence interval [CI], 82.8%-89.5%). Age 21 years or younger was associated with a higher hazard of graft failure (adjusted hazard ratio [aHR], 2.62; 95% CI, 1.49-4.61; p < 0.001). Concomitant chondral lesions were associated with a lower hazard of graft failure (aHR, 0.29; 95% CI, 0.11-0.73; p = 0.009). The 10-year contralateral ACL survival probability was 95.5% (95% CI, 92.9%-97.1%). Prior graft failure in the index knee was associated with contralateral ACL injury (aHR, 3.25; 95% CI, 1.00-10.53; p = 0.050). CONCLUSION: At a median follow-up of 10.6 years after primary hamstring autograft ACL reconstruction, graft survival was 86.6% and contralateral ACL survival was 95.5%. Younger age was associated with a higher hazard of graft failure, whereas concomitant chondral lesions were associated with a lower hazard of graft failure. Prior graft failure in the index knee was associated with subsequent contralateral ACL injury. LEVEL OF EVIDENCE: Level III.