外侧关节外腱固定术与轴移运动患者移植物失败及重返运动的关系：增强与单纯ACL重建的多中心比较研究
简介
一项多中心前瞻性队列研究纳入1260名从事旋转运动（足球、橄榄球）的运动员，比较5年随访中骨-髌腱-骨或腘绳肌腱自体移植物重建ACL时，是否联合外侧关节外肌腱固定术（LET）的疗效。结果显示，联合LET的两组移植物失败率均显著低于单纯重建组（0.8%–0.9% vs 75.9%–79.8%的重返运动率），且不依赖移植物类型。提示对高风险旋转运动员，ACL重建…
英文摘要
BACKGROUND: Anterior cruciate ligament (ACL) rupture is common in high-risk pivoting sports, with rerupture threatening athletic careers. Lateral extra-articular tenodesis (LET) has been proposed to reduce graft failure; nonetheless, comparative multicenter data across graft types remain limited. PURPOSE: To compare graft failure, return to sport, and functional outcomes after primary anterior cruciate ligament reconstruction using bone-patellar tendon -bone or semitendinosus autografts, with or without lateral extra-articular tenodesis, in competitive pivoting athletes. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The authors conducted a multicenter, prospective, intention-to-treat cohort study of 1260 competitive football and rugby athletes who underwent primary ACL reconstruction between 2018 and 2019. Participants were nonrandomly allocated to 4 groups according to graft choice and LET use, as determined by 16 individual treating surgeons: bone-patellar tendon-bone (BPTB) with modified Lemaire, semitendinosus tendon autograft (STRI) with modified Lemaire, isolated BPTB, and isolated STRI. At 5 years, evaluable follow-up data were available for 1186 of the 1260 athletes (94.1%). The primary endpoint was clinically relevant symptomatic knee instability consistent with graft failure, confirmed by imaging or revision surgery, defined as symptomatic knee instability confirmed by imaging or revision surgery. Follow-up included in-person medical examination with clinical stability testing when feasible and structured patient-reported questionnaires assessing knee stability and functional outcomes. RESULTS: Graft failure rates were similarly low in both augmented groups (0.8% for BPTB + Lemaire vs 0.9% for STRI + Lemaire groups), with no statistically significant difference between graft types and significantly lower than in nonaugmented reconstructions (P < .001). Return to sport (RTS) at the preinjury level at 18 months was achieved in 88.1% of athletes in the BPTB + Lemaire group and 82.7% in the STRI + Lemaire group, compared with 79.8% and 75.9% in isolated BPTB and STRI reconstruction groups, respectively (P < .001). Functional outcomes were similarly high in augmented groups, with mean International Knee Documentation Committee scores of 90.8 ± 6.8 for the BPTB + Lemaire group and 89.6 ± 7.2 for the STRI + Lemaire group, with no statistically significant differences between augmented graft types (P > .05). CONCLUSION: LET was associated with significantly reduced clinically relevant graft failure and reliable RTS in pivoting athletes, independent of graft type.