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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Allograft Augmentation of Hamstring Anterior Cruciate Ligament Grafts is Associated with Increased Graft Failure
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Allograft Augmentation of Hamstring Anterior Cruciate Ligament Grafts is Associated with Increased Graft Failure

机译：Ham绳肌前十字韧带移植物的同种异体移植增强与移植失败增加相关

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Objectives: ACL reconstruction in adolescents is commonly performed with hamstring autografts. In the adolescent population with very high activity levels, graft rupture is the most feared complication of ACL reconstruction. Young age, higher activity level, allografts, and small graft diameter have been shown to be predictors of graft failure. The applicability of this data to pediatric ACL reconstructions is limited due to heterogeneity of ages, graft constructs, and tunnel techniques. The purpose of this study is to evaluate the association of soft tissue graft constructs and graft rupture following pediatric transphyseal ACL reconstruction. Our hypothesis is that allograft-augmentation of grafts is associated with an increased risk of graft rupture. Methods: A single-institution retrospective review was performed of consecutive patients. Inclusion criteria were age less than 20 years and transphyseal ACL reconstruction with hamstring autograft, with or without allograft augmentation. Graft constructs included 4-strand doubled semitendinosus and gracilis (4-STG), 5-strand tripled semitendinosus and doubled gracilis (5-STG), 6-strand doubled gracilis and semitendinosus plus allograft (6-STGAllo), and 7-strand tripled semitendinosus and doubled gracilis plus allograft (7-STGAllo). Exclusion criteria included multiligament reconstruction and less than 6 months follow-up. The primary outcome was graft rupture. Results: Three hundred fifty-five patients (157 males, 198 females) with an average age of 15.3 years were identified to meet inclusion criteria. Graft constructs included 4-STG (198), 5-STG (91), 6-STGAllo (65), and 7-STGAllo (1). Average graft diameter was 8.3 mm 4-STG, 8.9 mm 5-STG, and 9.2 mm 6-STGAllo. Age and graft sizes were significantly different across groups with older patients (p <0.001) and larger graft sizes (p <0.001) being found in patients with allograft-augmented grafts. Mean duration of follow-up was 26 months (range 6-56 months). There were 51 graft ruptures (14.3%). The failure rate of each construct was 13.6% 4-STG, 11.9% 5-STG, and 19.7% 6-STGAllo. Time to graft failure was 16 months (range 2-40 months), with 49% of failures occurring before 12 months and 24% after 24 months. Twenty-four patients (6.7%) had a contralateral ACL tear during the follow-up period. Table 1 provides population characteristics by graft rupture status. This data suggests that patients who sustain a graft rupture may be slightly younger (p=0.07) and have lower BMI (p=0.07) than those patients without graft rupture. Odds ratios for graft failure by graft construct, controlling for age and graft size were calculated. Patients with 6-STGAllo grafts had an odds ratio of 2.6 (95% CI: 1.02, 6.50) of graft rupture as compared to 4-STG. Conclusion: ACL reconstruction with hamstring autograft combined with soft tissue allograft have a 2.6 times risk of graft rupture as compared to hamstring autograft without augmentation. In situations where the surgeon harvests an inadequately sized 4-strand autograft, we recommend tripling the semitendinosus to produce a larger graft diameter rather than augment with an allograft.
机译：目标：青少年的ACL重建通常使用绳肌自体移植进行。在活动水平非常高的青少年人群中，移植物破裂是ACL重建最令人担忧的并发症。年轻年龄，较高的活动水平，同种异体移植物和较小的移植物直径已被证明是移植物衰竭的预测因素。由于年龄，移植物构造和隧道技术的异质性，该数据在儿科ACL重建中的适用性受到限制。本研究的目的是评估小儿经trans动脉ACL重建术后软组织移植物构建体与移植物破裂的关联。我们的假设是同种异体移植物增强与移植物破裂风险增加有关。方法：对连续患者进行单机构回顾性审查。入选标准为年龄小于20岁，并进行绳肌自体移植，或有或没有同种异体移植，进行经phy骨ACL重建。嫁接构建体包括4链双半腱肌和鞭毛（4-STG），5链三重半腱肌和双鞭毛（5-STG），6链双鞭毛和半腱肌加同种异体移植物（6-STGAllo）和7链三链半腱肌和双gra肌加同种异体移植物（7-STGAllo）。排除标准包括多配体重建和少于6个月的随访。主要结果是移植物破裂。结果：确定平均年龄为15.3岁的355例患者（男性157例，女性198例）符合纳入标准。接枝构建物包括4-STG（198），5-STG（91），6-STGAllo（65）和7-STGAllo（1）。平均移植物直径为8.3 mm 4-STG，8.9 mm 5-STG和9.2 mm 6-STGAllo。在年龄较大的患者中，年龄和移植物尺寸之间存在显着差异（p <0.001），在同种异体移植后的移植物中患者的年龄和移植物尺寸较大（p <0.001）。平均随访时间为26个月（范围6-56个月）。有51例移植物破裂（14.3％）。每个构建体的失败率是13.6％4-STG，11.9％5-STG和19.7％6-STGAllo。移植失败的时间为16个月（范围2-40个月），其中49％的失败发生在12个月之前，而24％的发生在24个月之后。随访期间有24例患者（6.7％）有对侧ACL撕裂。表1按移植物破裂状态提供了种群特征。该数据表明，与未发生移植物破裂的患者相比，发生移植物破裂的患者可能更年轻（p = 0.07），并且其BMI较低（p = 0.07）。计算了通过移植物构建物，控制年龄和移植物大小控制的移植物失败几率。与4-STG相比，6-STGAllo移植患者的移植物破裂几率比为2.6（95％CI：1.02，6.50）。结论：自体ham绳肌联合软组织同种异体移植重建ACL的风险是不自体绳肌自体移植的2.6倍。在外科医生收获大小不足的4股自体移植物的情况下，我们建议将半腱肌增加三倍以产生更大的移植物直径，而不是用同种异体移植物进行扩大。

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