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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Anterior Cruciate Ligament Reconstruction in Young Females: Patellar versus Hamstring Tendon Autografts
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Anterior Cruciate Ligament Reconstruction in Young Females: Patellar versus Hamstring Tendon Autografts

机译：年轻女性的前十字韧带重建：Pat骨肌腱与Ham绳肌腱自体移植

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Objectives: Female athletes are two to eight times more likely to suffer a primary ACL tear than males. Although ACL reconstruction can successfully return many athletes to their pre-injury sports, re-injury to the ipsilateral or contralateral knee can occur in over 20% of young athletes. Both female sex and younger age have been shown to be risk factors for graft failure. The optimal graft choice for this high-risk population of young female athletes remains unknown and poorly studied. We compared the clinical outcomes in young female patients who underwent ACL reconstruction at our institution using bone-patellar tendon-bone (BTB) and quadrupled hamstring (HS) autografts. Methods: Female patients aged 15-25 who underwent primary ACL reconstruction at our institution between January 2012 and May 2015 using either BTB or HS autograft were included in our review. Patients were further sub-divided into 2 age groups, 15-20 and 20-25. Patients with a prior history of ACL injury to either knee, or those with multiligament injury were excluded. Graft choice and fixation method were documented from a review of operative records. Medical records were reviewed to document the occurrence of chondral, meniscal or ligamentous injury to the ipsilateral or contralateral knee in the first two years following ACL reconstruction. Comparisons were made using the chi-square test with statistical significance set at p < 0.05. Results: A total of 256 females were included in our review with 175 in the BTB group and 81 in the HS group. There was no difference between the groups with regards to average age or time to follow-up. The majority of patients in both groups, 80% of the BTB group and 77.8% of the HS group, were between the ages of 15-20. Interference screw fixation was used in all BTB cases and 63.0% of HS cases. In the remainder of HS cases, femoral suspension and tibial screw (27.2%), and femoral cross-pins and tibial screw (9.9%) were used. In our series, 22.2% of hamstring grafts were augmented with allograft due to inadequate size. Overall, graft re-tear occurred in 6.9% of BTB patients and 12.3% of HS patients [p=0.16]. Contralateral ACL tear occurred in 7.4% of BTB patients and 6.2% of HS patients [p=0.72]. Sub-group analysis showed that 75% of BTB and 100% of HS graft re-tears occurred in females aged 15-20. Within this group, there was a significantly lower rate of graft re-tears in the BTB group (6.4%) when compared to the HS group (15.9%) [p=0.04]. Allograft augmentation was used in four of the ten HS grafts that re-tore. The risk of failure with hamstring augmentation with allograft (4/18, 22.2%) was higher than that of hamstring autograft alone (6/63, 9.5%), but this difference was not significant [p=0.18]. Conclusion: The results of our study indicate that BTB autograft led to fewer graft re-tears compared to HS autograft following ACL reconstruction in female patients aged 15-20. However, this difference was not observed in females aged 20-25. Thus, further investigation regarding optimal graft choice is warranted in this age group.
机译：目标：女性运动员遭受原发性前交叉韧带撕裂的可能性是男性的两倍至八倍。尽管ACL重建可以成功地使许多运动员恢复受伤前的运动，但是20％以上的年轻运动员会发生同侧或对侧膝盖的再次损伤。雌性和较年轻的年龄都被证明是移植失败的危险因素。对于这种高风险的年轻女运动员，最佳的移植物选择仍然是未知的，而且研究还很差。我们比较了在我们机构中使用bone骨肌腱（BTB）和四倍rup绳肌（HS）自体移植进行ACL重建的年轻女性患者的临床结局。方法：本研究纳入2012年1月至2015年5月在我们机构接受BTB或HS自体移植的15-25岁女性患者进行原发ACL重建。将患者进一步分为2个年龄段：15-20和20-25。既往有膝盖ACL损伤史或多韧带损伤的患者被排除在外。通过回顾手术记录来记录移植物的选择和固定方法。回顾医疗记录，以记录在ACL重建后的头两年中，同侧或对侧膝盖发生软骨，半月板或韧带损伤的情况。使用卡方检验进行比较，统计显着性设置为p <0.05。结果：总共256名女性被纳入我们的评价，其中BTB组为175名，HS组为81名。两组之间在平均年龄或随访时间方面没有差异。两组的大多数患者，BTB组的80％和HS组的77.8％，年龄在15至20岁之间。所有BTB病例和63.0％的HS病例均使用干涉螺钉固定。在其余HS病例中，使用股骨悬吊和胫骨螺钉（27.2％），以及股骨交叉销和胫骨螺钉（9.9％）。在我们的系列中，由于大小不足，异体移植增加了22.2％的绳肌移植。总体而言，移植再撕裂发生在6.9％的BTB患者和12.3％的HS患者中[p = 0.16]。对侧ACL撕裂发生在7.4％的BTB患者和6.2％的HS患者中[p = 0.72]。亚组分析显示，15至20岁的女性中有75％的BTB和100％的HS移植物再次撕裂。在该组中，与HS组（15.9％）相比，BTB组的移植物再灌注率（6.4％）显着降低[p = 0.04]。十只HS移植物中有四只使用了同种异体移植。同种异体移植增加ham绳肌失败的风险（4 / 18，22.2％）高于单纯自体绳肌移植（6 / 63，9.5％）的风险，但这种差异并不显着[p = 0.18]。结论：我们的研究结果表明，在15至20岁的女性患者中，ACL重建后，与HS自体移植相比，BTB自体移植导致更少的移植物再流泪。但是，在20至25岁的女性中未观察到这种差异。因此，在这个年龄组中，关于最佳移植物选择的进一步研究是必要的。

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