生物性股薄肌联合髂胫束增强重建与腘绳肌腱加外侧肌腱固定术在ACL重建中的疗效比较：促进康复并降低并发症
简介
该研究比较了两种ACL重建技术：股薄肌生物增强的髂胫束自体移植物（ITBAG）与腘绳肌腱自体移植物联合阔筋膜外侧关节外腱固定术（HT-LET），评估重返运动率、功能评分及并发症。共纳入628例患者（每组314例），平均随访4.2年。两组重返运动率无显著差异（ITBAG 65.3% vs HT-LET 66.9%），但ITBAG组在Lysholm评分（96.5…
英文摘要
PURPOSE: To compare the iliotibial band autograft biologically augmented with gracilis (ITBAG) technique with a hamstring tendon autograft combined with extra-articular lateral tenodesis using fascia lata (HT-LET), in terms of (1) return-to-sport rates, (2) patient-reported functional outcomes and (3) complication rates. METHODS: This matched retrospective two-group study included patients from the FAST Cohort (French Prospective ACL Study). Patients who underwent revision for graft re-rupture were excluded from the comparative analyses of functional outcomes and return to sport. Return-to-sport status and level, subjective functional scores (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Outcome Score, Lysholm, Tegner, Anterior Cruciate Ligament-Return to Sport after Injury) and complications requiring reoperation were assessed after a minimum follow-up of 2 years. RESULTS: A total of 628 patients (314 in each group) were analysed. At a mean follow-up of 4.2 years, 65.3% (203/311) of ITBAG patients and 66.9% (204/305) of HT-LET patients had returned to sport (p = 0.73), with a mean time to return of 8.4 months and 8.9 months, respectively (p = 0.25). The ITBAG group demonstrated significantly better patient-reported outcomes in selected functional scores, including Lysholm (96.5 vs. 95) and ACL-RSI (87.5 vs. 79.2), while other functional measures were similar between groups. Re-rupture rates were low in both groups, occurring in 1% of patients in the ITBAG group and 2.9% in the HT-LET group (p = 0.14). However, the HT-LET group showed a higher incidence of other complications (p < 0.01), mainly due to postoperative cyclops syndrome. CONCLUSION: Although return-to-sport rates were comparable between techniques, ACL reconstruction using an iliotibial band graft augmented with gracilis resulted in superior functional scores and a lower rate of postoperative stiffness compared with hamstring autograft reconstruction with extra-articular lateral tenodesis. LEVEL OF EVIDENCE: Level III, cohort study.