在25岁以下患者中，单纯BPTB ACL重建较腘绳肌腱ACL重建联合ALL的移植物失败风险高4倍：一项随机对照试验的预设亚组分析
简介
这项RCT预设亚组分析纳入281例25岁以下ACL重建患者，比较单纯骨-髌腱-骨（BPTB）ACL重建与腘绳肌腱（HT）ACL重建联合前外侧韧带重建（ALLR）。5年随访显示，BPTB组移植物失败率16.4%，HT+ALLR组仅4.8%（OR 4.2），后者移植物生存显著更优，而IKDC、Lysholm等患者报告结局两组相当。提示年轻患者采用HT-ACLR+…
英文摘要
PURPOSE: To compare 5-year graft failure rates between isolated bone-patellar tendon-bone anterior cruciate ligament reconstruction (BPTB-ACLR) and hamstring tendon (HT)-ACLR combined with anterolateral ligament reconstruction (ALLR) in patients younger than 25 years. METHODS: A prespecified subgroup analysis was performed on patients younger than 25 years enroled in a prospective comparative study. Patients underwent either isolated ACLR using a BPTB-ACLR or hamstring ACLR combined with ALLR (HT-ACLR + ALLR). The primary outcome was graft failure at 5 years. Secondary outcomes included patient-reported outcome measures (Knee injury and Osteoarthritis Outcome Score [KOOS], International Knee Documentation Committee [IKDC], Lysholm and Tegner scores). Survival analysis was performed using Kaplan-Meier estimates and log-rank testing. Multivariate logistic regression and Cox proportional hazards models were used to identify independent risk factors for graft failure. RESULTS: The analysis included 281 patients younger than 25 years, with 134 undergoing isolated BPTB-ACLR and 147 undergoing HT-ACLR + ALLR. At 5 years, graft failure occurred in 22 patients (16.4%) in the isolated BPTB-ACLR group and in 7 patients (4.8%) in the HT-ACLR + ALLR group (p = 0.0013). Kaplan-Meier analysis demonstrated significantly improved graft survival in the HT-ACLR + ALLR group (log-rank p = 0.0008). On multivariate analysis, isolated BPTB-ACLR was independently associated with a higher risk of graft failure compared with HT-ACLR + ALLR (odds ratio 4.2; 95% confidence interval [CI] 1.8-11.3; p = 0.0007; hazard ratio 4.2; 95% CI 1.9-10.7; p = 0.0002). Clinical outcome scores were comparable between groups at follow-up across all patient-reported measures. CONCLUSION: This secondary analysis of a RCT with 5-year follow-up showed that, in patients younger than 25 years, HT-ACLR combined with ALLR was associated with a significantly lower risk of graft failure compared with isolated BPTB-ACLR, whereas patient-reported clinical outcomes were comparable between groups. LEVEL OF EVIDENCE: Level I, randomized controlled trial.