■进行前交叉韧带(ACL)重建(ACLR)时,有许多移植选择,尽管缺乏比较股四头肌(QT)和腿筋(HT)自体移植物的高质量证据。
■研究接受HT与QTACLR的患者的预后。
■随机对照试验;证据水平,1.
■招募和随机化后,112例患者(HT=55;QT=57)接受了ACLR。术前和术后(6周和3、6、12和24个月)对患者进行评估,使用一系列患者报告的结果测量(PROM),移植物松弛度(KT-1000关节计;主要结果变量),主动膝关节屈曲和伸展运动范围(ROM),峰值等速膝关节伸肌和屈肌强度,和一个6跳性能电池。计算了肢体对称指数(LSI)以进行强度和跳跃测量。次要程序,ACL重新撕毁,报告了对侧ACL撕裂。
■所有PROM和膝盖ROM措施都有了显着改善(P<.0001),除了前交叉韧带损伤后恢复运动(ACL-RSI)评分外,没有观察到其他组差异(P>0.05)。在3时,HT组明显更好(P=.008),6(P=.010),和12个月(P=0.014)。从6到24个月,没有观察到侧方松弛的显着变化(P=.105),在6(HT平均值,1.2;QT平均值,1.3),12(HT平均值,1.1;QT平均值,1.3),和24(HT是指,1.1;QT平均值,1.2个月。虽然HT组在6个月和12个月时表现出明显更大(P<0.05)的股四头肌强度LSI,QT组在第6、12和24个月时显示出更大的腿筋强度LSI(P<.05)。对于单个水平(6个月),HT组显示出明显更大的(P<0.05)LSI,横向(6个月和12个月),和中间(6个月)跳跃测试的距离。直到24个月,1例患者(22个月时的QT)有再次撕裂,2对侧ACL撕裂(QT在19个月;HT在23个月)。次要手术包括HT组5例(麻醉下操作,缺口清创,半月板修复,瘢痕组织的膝关节镜检查)和QT组的6(切口清创术,半月板修复,膝关节镜检查疤痕组织,胫骨结节转移,和骨软骨自体移植)。
■除了ACL-RSI,2组自体移植的PROM比较好,膝盖ROM,和松弛。然而,在QT队列中观察到更大的腿筋强度LSI,在HT队列中具有更大的股四头肌强度(和跳跃测试)LSI。长期审查将继续评估两种移植物结构之间的运动恢复和后期再损伤。
■ACTRN12618001520224p(澳大利亚新西兰临床试验注册中心)。
UNASSIGNED: Numerous graft options are available when undertaking anterior cruciate ligament (ACL) reconstruction (ACLR), although a lack of high-quality evidence exists comparing quadriceps (QT) and hamstring (HT) autografts.
UNASSIGNED: To investigate patient outcomes in patients undergoing HT versus QT ACLR.
UNASSIGNED: Randomized controlled
trial; Level of evidence, 1.
UNASSIGNED: After recruitment and randomization, 112 patients (HT = 55; QT = 57) underwent ACLR. Patients were assessed pre- and postoperatively (6 weeks and 3, 6, 12, and 24 months), with a range of patient-reported outcome measures (PROMs), graft laxity (KT-1000 arthrometer; primary outcome variable), active knee flexion and extension range of motion (ROM), peak isokinetic knee extensor and flexor strength, and a 6-hop performance battery. Limb symmetry indices (LSIs) were calculated for strength and hop measures. Secondary procedures, ACL retears, and contralateral ACL tears were reported.
UNASSIGNED: All PROMs and knee ROM measures significantly improved (P < .0001), and no other group differences (P > .05) were observed-apart from the Anterior Cruciate Ligament Return to Sport after Injury (ACL-RSI) score, which was significantly better in the HT group at 3 (P = .008), 6 (P = .010), and 12 (P = .014) months. No significant changes were observed in side-to-side laxity from 6 to 24 months (P = .105), and no group differences were observed (P = .487) at 6 (HT mean, 1.2; QT mean, 1.3), 12 (HT mean, 1.1; QT mean, 1.3), and 24 (HT mean, 1.1; QT mean, 1.2) months. While the HT group demonstrated significantly greater (P < .05) quadriceps strength LSIs at 6 and 12 months, the QT group showed significantly greater (P < .05) hamstring strength LSIs at 6, 12, and 24 months. The HT group showed significantly greater (P < .05) LSIs for the single horizontal (6 months), lateral (6 and 12 months), and medial (6 months) hop tests for distance. Up until 24 months, 1 patient (QT at 22 months) had a retear, with 2 contralateral ACL tears (QT at 19 months; HT at 23 months). Secondary procedures included 5 in the HT group (manipulation under anesthesia, notch debridement, meniscal repair, and knee arthroscopy for scar tissue) and 6 in the QT group (notch debridement, meniscal repair, knee arthroscopy for scar tissue, tibial tubercle transfer, and osteochondral autologous transplantation).
UNASSIGNED: Apart from the ACL-RSI, the 2 autograft groups compared well for PROMs, knee ROM, and laxity. However, greater hamstring strength LSIs were observed for the QT cohort, with greater quadriceps strength (and hop test) LSIs in the HT cohort. The longer-term review will continue to evaluate return to sports and later-stage reinjury between the 2 graft constructs.
UNASSIGNED: ACTRN12618001520224p (Australian New Zealand Clinical Trials Registry).