在股四头肌自体移植物前交叉韧带重建术中增加外侧关节外肌腱固定术可降低移植物失败风险
简介
该回顾性研究比较了股四头肌腱自体移植物前交叉韧带重建（ACLR）加或不加改良Lemaire外侧关节外肌腱固定术（LET）的临床结果。结果显示，加LET组移植物总失败率（14.8% vs 29.6%）和残留轴移比例（11.3% vs 26.3%）均显著低于单纯ACLR组，且重返运动时间更短（8.8个月 vs 9.7个月）。对于术前轴移≥2级或计划重返旋转运动的…
英文摘要
PURPOSE: The purpose of this study was to compare graft failure and clinical outcomes following primary anterior cruciate ligament reconstruction (ACLR) using quadriceps tendon autograft (QA), with or without a modified Lemaire lateral extra-articular tenodesis (LET). METHODS: Patients with ACL deficiency who underwent primary QA ACLR with or without LET and completed at least 2-year follow-up were included. Patients with a Beighton score ≥4, a preoperative pivot shift grade ≥2, or an intention to return to cutting and pivoting sports were offered LET. The primary outcome variable assessed was graft failure as defined by graft rupture or grade ≥2 pivot shift at any point postoperatively. Secondary outcomes included return to sport clearance rates, the International Knee Documentation Committee and Lysholm scores and postoperative complications. RESULTS: There were 122 undergoing QA ACLR with LET (QA + LET group) and 152 undergoing isolated QA ACLR (QA group). The QA + LET group had a significantly lower failure rate of 14.8% versus 29.6% in the QA group (P = .02). In addition, the QA + LET group had a lower residual pivot shift rate compared with the QA group (11.3% vs. 26.3% respectively; P = .01). There was no difference in graft retear rates between the 2 groups (P = .37). The QA + LET returned to sport significantly faster at 8.8 months compared with 9.7 months in the QA group (P = .038). CONCLUSIONS: The addition of LET to QA ACLR was associated with a significantly lower overall graft failure rate and lower percentage of patients with residual pivot shifts after ACLR compared with QA alone at 2-year follow up. However, there was no difference between the 2 groups with regard to graft retear rates. The addition of an LET to QA ACLR also allowed athletes to return to sports faster compared with QA alone. LEVEL OF EVIDENCE: Level III, retrospective comparative study.