大尺寸移植物对比标准尺寸移植物联合前外侧韧带重建治疗ACL功能不全膝关节：一项随机对照试验
简介
一项随机对照试验纳入82例ACL损伤患者（18-45岁），比较了大直径（6股腘绳肌腱，平均9.5 mm）移植物与标准直径（4股腘绳肌腱，平均8.0 mm）移植物联合前外侧韧带（ALL）重建的临床效果。主要结局为膝关节稳定性（轴移试验、Lachman试验）和功能评分（Lysholm、IKDC），随访24个月。结果显示：两组Lysholm评分均显著改善（A组51…
英文摘要
BACKGROUND: Anterior cruciate ligament (ACL) injuries are highly prevalent among athletes and continue to pose challenges owing to persistent instability and variable return-to-sport outcomes following reconstruction. Anterolateral ligament (ALL) reconstruction and has been introduced to improve outcomes. Increasing graft diameter was described to enhance biomechanical properties. This study hypothesis was, that ACL reconstruction (ACL-R) combined with ALL reconstruction is superior to a large-sized graft ACL-R. PURPOSE: To compare outcomes of large-sized (six-strand) hamstring grafts with those of standard-sized (four-strand) grafts combined with anterolateral ligament (ALL) reconstruction in ACL-deficient knees. METHODS: A total of 82 patients (18-45 years) undergoing ACL reconstruction were randomized to either a large (six-strand) hamstring graft group (group A, n = 41) or a standard-sized (four-strand) graft plus ALL reconstruction group (group B, n = 41). Primary outcomes were knee stability (pivot-shift and Lachman tests) and functional scores [Lysholm and International Knee Documentation Committee (IKDC) scores]. Secondary measures included pain scores, return to sport, and complication rates, with follow-up at 24 months. RESULTS: The mean diameter of the large-sized graft was 9.5 ± 2.5 mm, while the mean diameter of the standard-sized graft was 8.0 ± 2.0 mm. Both groups demonstrated significant gains in stability and function. Lysholm scores improved from 51 to 94 in group A and from 56 to 98 in group B with no significant difference between both groups (p = 0.418), while IKDC scores rose from 37 to 88 and from 37 to 91, respectively and it was significantly higher in group B (p = 0.036). Negative pivot-shift was observed in 87.8% of group A and 90.2% of group B with no significant intergroup difference (p = 0.841). Return-to-sport at 12 months was 93.5% and 96.1%, respectively with no significant difference (p = 1.00). Graft rupture occurred in 4.8% of group A and 2.4% of group B. Overall complications were low and statistically comparable (p = 1.00). CONCLUSIONS: Both large hamstring grafts and standard grafts augmented with ALL reconstruction provided significant functional and stability improvements, with no major differences between techniques.