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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Radiographic Osteoarthritis, Clinical Outcomes and Re-Injury 20 Years after ACL Reconstruction
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Radiographic Osteoarthritis, Clinical Outcomes and Re-Injury 20 Years after ACL Reconstruction

机译：ACL重建后20年的影像学骨关节炎，临床结果和再损伤

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Objective: This prospective longitudinal study compares the outcome of isolated endoscopic ACL reconstruction utilizing 4-strand hamstring tendon (HT) and patellar tendon (PT) autograft over a 20-year period. Method: Observational Series. 90 consecutive patients with isolated ACL rupture were reconstructed with a PT autograft and 90 patients received HT autograft, with an identical surgical technique. Patients were assessed at 2, 5, 7, 10, 15 and 20 years. Assessment included the IKDC Knee Ligament Evaluation including radiographic evaluation, KT1000, Lysholm Knee Score, kneeling pain, and clinical outcomes. Results: Subjects who received the PT graft had significantly worse outcomes compared to those who received the HT graft at 20 years for the variables of radiologically detectable osteoarthritis (59% v 39%, p=0.01), kneeling pain (38% v 20%, p=0.02), and incidence of contralateral ACL injury (30% v 14%, p=0.04). There was no significant difference between the HT and PT groups in overall IKDC grade (p=0.23), or IKDC subjective score (p=0.18). Subgroup gender differences were identified. The female PT group had significantly lower mean IKDC subjective scores (p=0.05), and more difficulty with kneeling (p=0.04) compared to the other subgroups. ACL graft rupture occurred in 18% of HT and 10% of the PT (p=0.13), and was associated with males (Hazard Ratio(HR)=3.9, p=0.007), age <18 years (HR=4.6, p=0.003), and non ideal radiological tunnel placement (HR=3.6, p=0.02). Contralateral ACL injury was associated with age <18 years (HR=3.4, p=0.001), and the PT graft (HR=2.2, p=0.02). Conclusion: At 20 years both HT and PT autografts continue to provide good subjective outcomes and objective stability. However, ACL reconstruction using the PT graft is associated with persisting kneeling pain and radiological osteoarthritis, compared to the HT graft. Risk factors for ACL graft rupture include males, young age, and those with tunnel malposition. This information may help in the counseling of patients undergoing this procedure and stratifying their individual risk of re-injury.
机译：目的：这项前瞻性纵向研究比较了20年来使用4股绳肌腱（HT）和pa骨肌腱（PT）自体移植进行的独立内镜ACL重建的结果。方法：观察系列。采用相同的手术技术，对90例连续的ACL破裂独立患者进行了重建，对90例进行了HT自体移植。在2、5、7、10、15和20岁时对患者进行评估。评估包括IKDC膝关节韧带评估，包括射线照相评估，KT1000，Lysholm膝关节评分，跪痛和临床结果。结果：与20年时接受HT移植的患者相比，在影像学上可检测到的骨关节炎变量（59％对39％，p = 0.01），跪痛（38％对20％）的影响下，接受PT移植的患者的结局明显较差。 ，p = 0.02）和对侧ACL损伤的发生率（30％vs 14％，p = 0.04）。 HT组和PT组之间在IKDC总体评分（p = 0.23）或IKDC主观评分（p = 0.18）之间没有显着差异。确定亚组的性别差异。与其他亚组相比，女性PT组的IKDC主观平均得分显着较低（p = 0.05），并且下跪的难度更大（p = 0.04）。 ACL移植物破裂发生在HT的18％和PT的10％（p = 0.13），并且与男性（危险比（HR）= 3.9，p = 0.007），年龄<18岁（HR = 4.6，p = 0.003）和非理想的放射隧道位置（HR = 3.6，p = 0.02）。对侧ACL损伤与年龄<18岁（HR = 3.4，p = 0.001）和PT移植物（HR = 2.2，p = 0.02）相关。结论：HT和PT自体移植在20年后均继续提供良好的主观结果和客观稳定性。然而，与HT移植相比，使用PT移植进行ACL重建与持续的下跪疼痛和放射性骨关节炎有关。 ACL移植物破裂的危险因素包括男性，年轻和有隧道错位的人。该信息可能有助于咨询接受该程序的患者，并对其个人再次受伤的风险进行分层。

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