腓骨长肌自体移植物在前交叉韧带重建术中虽保留膝关节功能但损害踝关节力量、平衡及跳跃表现：一项一年比较研究
简介
一项回顾性比较研究纳入60例ACL重建患者，对比腓骨长肌腱与半腱肌腱自体移植物术后12个月的临床与功能结果。两组IKDC、Lysholm评分无显著差异，但PLT组踝关节跖屈和外翻肌力明显下降，单腿跳、垂直跳及落地稳定性的肢体间不对称性显著增大。提示PLT取腱虽不影响主观膝关节评分，但会造成供区踝功能缺陷，对依赖踝稳定性的运动员应谨慎选择。
英文摘要
PURPOSE: This study aimed to comprehensively compare the effects of peroneus longus tendon (PLT) and semitendinosus tendon (ST) autografts on knee and ankle isometric strength asymmetries, jump performance, postural stability, and patient-reported outcome measures (PROMs) in patients 12 months after isolated anterior cruciate ligament reconstruction (ACLR). METHODS: In this retrospective study, 98 eligible patients underwent propensity score matching. After dropouts, 60 patients (ST: n = 30; PLT: n = 30) were evaluated 12 months postoperatively. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC), Lysholm, Tegner, and American Orthopaedic Foot and Ankle Society (AOFAS) scales. Functional assessments included single-leg hop tests (SLHTs), countermovement jump (CMJ), drop jump (DJ), single-leg jump (SLJ), single-leg drop jump (SLDJ), land-and-hold (LH), and single-leg stance (SLS) tests. Isometric strength for knee flexion/extension and ankle plantar flexion/eversion was measured. Two separate 2 × 2 mixed-design ANOVAs were utilized to evaluate time-dependent and inter-limb (operative vs. contralateral) differences across groups. RESULTS: Both groups demonstrated significant time-dependent improvements in IKDC, Lysholm, and Tegner scores (p < 0.05), with no significant inter-group differences. However, the PLT group showed significantly higher inter-limb functional asymmetry in SLHTs (14.06%-21.34%) compared to the ST group (3.95%-7.85%). Significant group × limb interactions were observed for knee extension strength (p = 0.025), along with considerable deficits in ankle plantar flexion (p < 0.001) and eversion (p < 0.001) strengths specifically in the PLT group. Inter-limb asymmetry in jump height and landing force was considerably more pronounced in the PLT group in all vertical jump variations. Furthermore, the PLT group showed significantly impaired dynamic stabilization, with longer time to stabilization (TTS) and increased anterior-posterior postural sway during LH and SLS (p < 0.05). CONCLUSIONS: While subjective clinical scores are comparable, PLT autografts result in significant donor-site strength deficits and increased inter-limb functional asymmetry at the 12-month follow-up. These functional deficits suggest that PLT autografts should be used with caution, particularly in athletes who depend on optimal ankle stability for athletic performance.