社论评论：全内腘绳肌腱前交叉韧带重建长期随访失败率高——问题在移植物而非重建结构，但未来不断使过去复杂化
简介
这篇评论围绕全内腘绳肌腱自体移植物ACL重建长期随访失败率高的问题，讨论失败应归因于移植物还是重建结构。作者指出，腘绳肌腱重建随移植物构型、骨道钻取和可调袢皮质固定等技术演变而改变，移植物伸长、各束负荷不均、可调袢延长及皮质固定工作长度较长均可能是相关因素；但腘绳肌腱自体移植物的翻修率升高在现代全内技术普及前已被观察到，提示固定方式本身不能解释这一信号，而全…
英文摘要
Recent reports of high failure rates after all-inside hamstring autograft anterior cruciate ligament reconstruction have renewed an old debate: is the problem the graft, the construct, or both? Interpretation is difficult because hamstring anterior cruciate ligament reconstruction has evolved alongside changes in graft configuration, socket drilling, and adjustable-loop cortical fixation. Potential contributors include graft elongation, unequal strand loading, adjustable-loop lengthening, and the longer working length of cortical fixation. Yet higher revision rates with hamstring autografts were identified before widespread adoption of the modern all-inside technique, suggesting that fixation alone does not explain the signal. Meanwhile, all-inside techniques have increasingly been paired with quadriceps tendon autograft without the same apparent failure concern. The literature remains messy, but the simplest explanation may still be the correct one: hamstring autograft itself appears less forgiving in higher-risk patients. For those patients, quadriceps or patellar tendon autograft remains the more reliable choice.