■使用自体移植重建仍然是前交叉韧带(ACL)损伤的黄金标准手术治疗。然而,高达10%至15%的患者将在未来遭受移植失败。尸体研究表明,在ACL自体移植物结构中添加缝合胶带增强可以增加移植物强度并降低周期性负荷下的伸长率。
■本研究旨在调查ACL重建(ACLR)后的临床结果和再破裂率。我们假设用缝合胶带增加会导致较低的再破裂率。
■案例系列;证据级别,4.
■在2015年至2019年期间,前瞻性招募了使用缝合带增强的腿筋或髌腱自体移植物进行原发性ACLR的患者。排除了多韧带损伤或同时进行外侧关节外手术的患者。患者观察6个月,并在术后2年和5年收集患者报告的结局指标(PROM)。所有患者都联系了,和记录进行审查,以确定移植物失败的发生率。收集的PROM如下:膝关节损伤和骨关节炎结果评分(KOOS),退伍军人兰德12项健康调查(VR-12),Tegner和马克思的活动得分,疼痛视觉模拟量表(VAS)。
■共有97名患者,平均年龄为34.7(±13.4)岁,包括(76%的男性;52个腿筋和45个髌骨肌腱移植物)。平均移植物直径为8(±1)mm。术后平均5年可接触的90例患者中有1例(1.1%)再破裂。2年时KOOS得分中位数如下:疼痛,94;症状,86;日常生活活动,99;体育和娱乐,82;和生活质量,81.术后评分明显高于术前评分(P<.001)。VR-12物理评分从术前的43提高到2年的55,并在5年保持在56。VAS疼痛,Tegner,和马克思的得分分别为0、6和9,术后2年。移植物类型之间的PROM没有差异。
■这项研究表明,对于腿筋和髌腱移植物,自体移植物ACLR的缝合带增强效果令人鼓舞。平均随访5年的失败率为1.1%,低于已发表的重建率,和PROM结果令人满意。该技术使用安全,可以恢复到受伤前的运动水平,再受伤的机会较低。
Reconstruction using autograft remains the gold standard surgical treatment for anterior cruciate ligament (ACL) injuries. However, up to 10% to 15% of patients will suffer a graft failure in the future. Cadaveric studies have demonstrated that the addition of suture tape augmentation to ACL autograft constructs can increase graft strength and reduce elongation under cyclical loading.
This study aimed to investigate the clinical outcomes and rerupture rates after ACL reconstruction (ACLR) with suture tape augmentation. We hypothesized that augmentation with suture tape would lead to lower rerupture rates.
Case series; Level of evidence, 4.
Patients undergoing primary ACLR using hamstring or patellar tendon autografts augmented with suture tape between 2015 and 2019 were recruited prospectively. Patients with multiligament injuries or a concomitant lateral extra-articular procedure were excluded. Patients were observed in person for 6 months, and patient-reported outcome measures (PROMs) were collected at 2 and 5 years postoperatively. All patients were contacted, and records were reviewed to determine the incidence of graft failure. PROMs collected were as follows: Knee injury and Osteoarthritis Outcome Score (KOOS), Veterans RAND 12-Item Health Survey (VR-12), Tegner and Marx activity scores, and visual analog scale for pain (VAS).
A total of 97 patients, with a mean age of 34.7 (±13.4) years, were included (76% men; 52 hamstring and 45 patellar tendon grafts). The mean graft diameter was 8 (±1) mm. There was 1 rerupture (1.1%) out of the 90 patients who were contactable at a mean of 5 years postoperatively. Median KOOS scores at 2 years were as follows: Pain, 94; Symptoms, 86; Activities of Daily Living, 99; Sport and Recreation, 82; and Quality of Life, 81. The postoperative scores were significantly higher than the preoperative scores (P < .001). The VR-12 Physical score improved from 43 preoperatively to 55 at 2 years and remained at 56 at 5 years. The VAS pain, Tegner, and Marx scores were 0, 6, and 9, respectively, at 2 years postoperatively. There was no difference in PROMs between graft types.
This study demonstrates encouraging results of suture tape augmentation of autograft ACLR for both hamstring and patellar tendon grafts. The failure rate of 1.1% at a mean follow-up of 5 years is lower than published rates for reconstruction, and PROMs results are satisfactory. The technique is safe to use and may permit a return to the preinjury sporting level with a lower chance of reinjury.