移植物类型与足球运动员ACL翻修重建无关：一项后续ACL重建的全国队列分析
简介
瑞典一项全国性队列研究纳入10693名足球运动员（含6238名重返比赛者），比较腘绳肌腱、髌腱与股四头肌腱自体移植物对ACL重建术后翻修及对侧ACL损伤风险的影响。平均随访5.2年显示，移植物类型与同侧翻修风险无关，但女性使用股四头肌腱者对侧ACL重建风险显著升高（HR 1.98），且年龄与术前竞技水平是后续ACL损伤的一致预测因素。提示对年轻女性患者选择股…
英文摘要
OBJECTIVE: To determine whether autograft type (hamstring, patellar or quadriceps tendon) is associated with risk of revision anterior cruciate ligament reconstruction (ACLR) or contralateral ACLR in football players. METHODS: Nationwide cohort included all primary ACLRs performed in registered football players in Sweden between 2014 and 2023, identified by linkage of the Swedish Knee Ligament Registry and the Swedish Football Association. Return to competition (RTC) was defined as participation in at least one official match. Outcomes were revision ACLR (index knee) and contralateral ACLR. Sex stratified, cause specific Cox models adjusted for age and pre-injury level of play (Elite, Non-elite, Youth) were used, with hamstring tendon as graft reference. RESULTS: A total of 10 693 players were included, of whom 6238 (58%) RTC, mean age 22±7 years, mean follow up 5.2±2.9 years. Among RTC players, revision ACLR occurred in 232 women (10.8%) and in 349 (9.2%) men with no association between graft type and revision ACLR. Contralateral ACLR occurred in 263 women (12.2%) and 264 (6.9%) men. In women, quadriceps tendon was associated with a higher hazard of contralateral ACLR (HR 1.98, 95% CI 1.17 to 3.36). No graft-specific differences were seen in age-restricted sensitivity analyses or in the full cohort. Younger age and higher pre-injury level were consistently associated with greater subsequent ACLR risk. CONCLUSIONS: Graft choice was not independently associated with revision ACLR, including among young football players who RTC. An association between quadriceps tendon autograft and contralateral ACLR was observed among women. Across analyses, age and pre-injury level of play were the most consistent correlates of subsequent ACLR risk.