儿童ACL重建术后关节纤维化：相关因素与移植物类型的作用，一项回顾性研究
简介
这项回顾性研究比较了154例平均15.1岁、接受初次ACL重建的儿童患者，其中腘绳肌腱（HT）自体移植物84例、股四头肌腱（QT）自体移植物70例；关节纤维化定义为伸膝丢失≥10°、屈膝丢失≥20°或存在机械症状。QT组关节纤维化发生率为7%，高于HT组的0%（P=0.018），同时QT组关节软骨损伤比例更高（39% vs 20%，P=0.020）。发生关节…
英文摘要
BACKGROUND: Arthrofibrosis is a challenging complication that can occur after anterior cruciate ligament reconstruction (ACLR), restricting range of motion and impairing function. Risk factors have been identified for arthrofibrosis in adults, but data in pediatric patients are limited, particularly regarding the role of graft type. In this study, we compared clinical, surgical, and postoperative variables between pediatric patients who underwent ACLR with hamstring tendon (HT) autograft or quadriceps tendon (QT) autograft and assessed associations between arthrofibrosis development and postoperative clinical outcomes. METHODS: We retrospectively compared data from 154 pediatric patients (mean±SD age 15.1±1.8 years; 46% female) who underwent primary ACLR using HT (n=84) or QT (n=70) autografts from June 2015 to June 2024. We excluded patients with concomitant ligament injuries, prior ACLR, lateral extraarticular tenodesis, chondral procedures, or <5-month follow-up. Arthrofibrosis was defined as loss of ≥10 degrees of knee extension, loss of ≥20 degrees of knee flexion, or mechanical symptoms. Statistical analyses comprised Fisher exact tests, t tests, and Wilcoxon rank-sum tests. α=0.05. RESULTS: Compared with the HT group, the QT group had higher incidence of chondral injury (39% vs. 20%, P=0.020), higher incidence of positive Lachman test (100% vs. 85%, P=0.004), higher incidence of arthrofibrosis (7% vs. 0%, P=0.018), and a larger mean graft diameter (8.8±0.8 vs. 8.1±0.8 mm, P<0.001). The HT group had longer mean operative time (161±33 min) than the QT group did (142±35 min) (P<0.001). Patients who developed arthrofibrosis had less knee extension at 5 months postoperatively (9±0.6 degrees vs. -0.4±2 degrees, P=0.018) and greater incidence of additional surgery (100% vs. 14%, P<0.001) compared with those who did not develop arthrofibrosis. CONCLUSIONS: In pediatric patients who underwent ACLR, QT autografts were associated with higher incidence of arthrofibrosis and postoperative stiffness compared with HT autografts. These results suggest that graft selection may influence postoperative motion and should be tailored to individual patient factors, including concomitant chondral injury and baseline ligamentous laxity. LEVEL OF EVIDENCE: Level III.