一级运动员前交叉韧带重建翻修术：骨-髌腱-骨与腘绳肌腱自体移植物联合或不联合外侧关节外肌腱固定术的疗效相似
简介
本研究纳入262例一级运动员ACL翻修患者，比较骨-髌腱-骨与腘绳肌腱自体移植物，及是否联合关节外肌腱固定术（LEAT）的疗效。2年随访显示，两组重返运动率（约63–65%）及移植物再断裂率无显著差异，LEAT亦未降低再伤率；年龄每增加1岁，重返运动几率下降6.9%。提示翻修时移植物选择对一级运动员预后影响有限，而年龄是更关键的决定因素。
英文摘要
INTRODUCTION: This study reports Revision Anterior Cruciate Ligament Reconstruction (R-ACLR) outcomes using Bone-Patellar Tendon-Bone (BPTB) vs. Hamstring (HT) autografts with and without lateral extra-articular tenodesis (LEAT) in a cohort of level 1 athletes. METHODS: A consecutive cohort of 262 athletes who underwent R-ACLR between 2014 and 2018 were analysed. The decision to augment revision ACLR with LEAT was guided by younger age and generalised hypermobility. There were 157 patients in the BPTB cohort (BPTB = 53 vs. BPTB + LEAT = 104) and 105 patients in the HT cohort (HT = 32 vs. HT + LEAT = 73). Return to Play (RTP), ipsilateral/contralateral ACL injuries and patient-reported outcome measures (International Knee Documentation Committee Score (IKDC), Marx) were assessed at 2 years. RESULTS: The mean age was 25.4 +/- 6.3 years and 84.4% of patients were male. RTP rates (BPTB +/- LEAT: 65.2% vs. HT +/- LEAT: 62.8%; p=.400) and time to RTP (13.3 ± 5.7 vs. 12.4 ± 6.1 months) were comparable. Increasing age was independently associated with reduced odds of return to play, with each additional year associated with a 6.9% reduction in the odds of RTP (OR 0.93, 95% CI 0.89-0.98; p = 0.005). There was no statistically significant difference in graft re-injury rates with or without LEAT (BPTB vs. BPTB + LEAT: 1.9% (1/52) vs. 2.9% (3/2.9), p=.720) and (HT vs. HT + LEAT: 6.3% (2/30) vs. 1.4% (1/72), p=.163). There was no statistically significant difference in IKDC score (BPTB: 83.3 +/- 11.7 vs. HT: 83.6 +/- 13.9, p = .885). Both cohorts demonstrated a reduction in Marx score from their preoperative levels (BPTB +/- LEAT: 10.7 to 8.1 vs. HT +/- LEAT: 11.1 to 8.7). CONCLUSION: This study demonstrated that using ipsilateral BPTB and HT autografts for R-ACLR in level 1 athletes resulted in no statistically significant difference in RTP, re-injury and patient-reported outcomes. There was also no difference in re-injury rate in the group that received LEAT. Interestingly, although patients in the LEAT group were younger and had a lower incidence of chondral injuries, this did not translate into improved patient-reported outcomes. Notably, all patients' activity levels were substantially reduced after revision ACLR, regardless of the type of graft used. LEVEL OF EVIDENCE 3: Cohort study.