科研之友
微信
新浪微博
Facebook
分享链接
摘要
Background: Graft failure and low rates of return to sport are major concerns after anterior cruciate ligament (ACL) reconstruction, particularly in a population at risk. @@@ Purpose: To evaluate the association between reconstruction techniques and subsequent graft rupture and return-to-sport rates in patients aged 16 to 30 years participating in pivoting sports. @@@ Study Design: Cohort study; Level of evidence, 2. @@@ Methods: A prospective study of patients undergoing primary ACL reconstruction with a bone-patellar tendon-bone (B-PT-B) graft, quadrupled hamstring tendon (4HT) graft, or hamstring tendon graft combined with anterolateral ligament reconstruction (HT+ALL) was conducted by the Scientific ACL NeTwork International (SANTI) Study Group. Survivorship data from Kaplan-Meier analysis were analyzed in multivariate Cox regression models to identify the prognosticators of graft ruptures and return to sport. @@@ Results: Five hundred two patients (mean age, 22.4 4.0 years) with a mean follow-up of 38.4 +/- 8.5 months (range, 24-54 months) were included. There were 105 B-PT-B, 176 4HT, and 221 HT+ALL grafts. The mean postoperative scores at latest follow-up were the following: Lysholm: 92.4 +/- 8.6, Tegner: 7.4 +/- 2.1, and subjective International Knee Documentation Committee (IKDC): 86.8 +/- 10.5 for B-PT-B grafts; Lysholm: 91.3 +/- 9.9, Tegner: 6.6 +/- 1.8, and subjective IKDC: 85.4 +/- 10.4 for 4HT grafts; and Lysholm: 91.9 +/- 10.2, Tegner: 7.0 +/- 2.0, and subjective IKDC: 81.8 +/- 13.1 for HT+ALL grafts. The mean side-to-side laxity was 0.6 +/- 0.9 mm for B-PT-B grafts, 0.6 +/- 1.0 mm for 4HT grafts, and 0.5 +/- 0.8 mm for HT+ALL grafts. At a mean follow-up of 38.4 months, the graft rupture rates were 10.77% (range, 6.60%-17.32%) for 4HT grafts, 16.77% (range, 9.99%-27.40%) for B-PT-B grafts, and 4.13% (range, 2.17%-7.80%) for HT+ALL grafts. The rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts (hazard ratio [HR], 0.393; 95% CI, 0.153-0.953) and 3.1 times less than with 4HT grafts (HR, 0.327; 95% CI, 0.130-0.758). There was no significant difference in the graft failure rate between 4HT and B-PT-B grafts (HR, 1.204; 95% CI, 0.555-2.663). Other prognosticators of graft failure included age 25 years (P = .012) and a preoperative side-to-side laxity >7 mm (P = .018). The HT+ALL graft was associated with higher odds of returning to preinjury levels of sport than the 4HT graft (odds ratio [OR], 1.938; 95% CI, 1.174-3.224) but not compared with the B-PT-B graft (OR, 1.460; 95% CI, 0.813-2.613). @@@ Conclusion: In a high-risk population of young patients participating in pivoting sports, the rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts and 3.1 times less than with 4HT grafts. The HT+ALL graft is also associated with greater odds of returning to preinjury levels of sport when compared with the 4HT graft.
- 出版日期2017-6
