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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >A prospective study of bone-tendon-bone ACL reconstruction with and without lateral extra-articular tenodesis: 19-year clinical and radiological follow-up
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A prospective study of bone-tendon-bone ACL reconstruction with and without lateral extra-articular tenodesis: 19-year clinical and radiological follow-up

机译：伴或不伴外侧关节外伸肌腱的骨-腱-骨ACL重建的前瞻性研究：19年的临床和影像学随访

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Objectives Anterior cruciate ligament (ACL) arthroscopic reconstruction with a patellar tendon graft (BTB) is a well-known and reliable surgical option for control of anterior laxity, at short and middle term. Most of those patients are young and practice sports, often at high level. Few studies have evaluated the long term effects of ACL reconstruction, and more specifically lateral tenodesis, on knee function. It has been shown that chronic anterior instability, when left untreated, evolves towards femorotibial osteoarthritis in the 10 to 20 years after ACL rupture. This study aims to compare long-term survival and femorotibial arthritis between ACL reconstruction with and without lateral tenodesis. Methods 121 consecutive knees (120 patients) presenting with an ACL rupture between 1998 and 1999 were included in this prospective randomized monocentric study. For the 61 knees in group BTB, an isolated patellar tendon plasty with outside-in technique was performed. For 60 knees in group BTB-T, the intra-articular plasty was associated with a lateral tenodesis with gracilis tendon. Patients were reviewed at 1 year, 6 years and 19 years post-operatively. Results 80 patients were contacted with a minimum follow-up of 19 years. 43 patients had a clinical examination and the 37 other patients were evaluated through a telephone questionnaire. We had standard X-rays for 45 patients and laximetry (TELOS?) for 42 patients. 41 patients (34%) were lost to follow-up. 16 knees (20%) had experienced a graft failure, 5 of which had had an iterative ACL plasty. The difference between group BTB (27.5%) and group BTB-T (13.2%) concerning graft failure was not statistically significant (p = 0.38). 32 patients (71%) had femorotibial osteoarthritis (IKDC grade C or D). There was no difference between groups BTB and BTB-T concerning medial femorotibial osteoarthritis. Lateral femorotibial osteoarthritis was significantly increased in groupe BTB-T (59%) compared to group BTB (21%) and to the contralateral knee (5%). 36 patients (45%) had had a lateral or medial meniscectomy. Mean subjective IKDC score was 81.8/100, comparable between groups BTB and BTB-T. 67% still practiced pivot sports. Conclusion At 19 years follow-up after patellar tendon ACL plasty, lateral tenodesis did not significantly improve graft survival in our study. Lateral femorotibial osteoarthritis was significantly increased in patients with a lateral tenodesis. However, a follow-up bias may be that lesions of the lateral meniscus were more frequent in BTB-T patients for whom we obtained X-rays. Functional scores were stable at over 80/100 and two thirds of patients still practiced pivot sports. ACL graft survival was 80% at 20 years follow-up.
机译：目的使用tell骨肌腱移植物（BTB）进行前十字韧带（ACL）关节镜重建术是在短期和中期控制前松弛的一种众所周知的可靠手术选择。这些患者中的大多数都是年轻的并且经常参加高级运动。很少有研究评估ACL重建（尤其是外侧腱固定术）对膝关节功能的长期影响。已经显示，如果不进行治疗，慢性前路不稳定性会在ACL破裂后的10到20年内发展为股骨骨关节炎。这项研究的目的是比较ACL重建与无侧肌腱固定术之间的长期生存和股胫关节炎。方法这项前瞻性随机单中心研究纳入了1998年至1999年间121例连续的膝关节（120例患者）出现ACL破裂。对于BTB组中的61膝，进行了由外而内的孤立technique骨腱成形术。对于BTB-T组中的60个膝盖，关节内成形术与外侧腱索伴有束状肌腱相关。术后1年，6年和19年对患者进行检查。结果80例患者接受了至少19年的随访。 43名患者接受了临床检查，另外37名患者通过电话问卷进行了评估。我们对45例患者进行了标准X射线检查，对42例患者进行了X射线测定（TELOS？）。 41名患者（占34％）失去随访。 16个膝盖（占20％）经历了移植物衰竭，其中5个进行了ACL迭代成形术。 BTB组（27.5％）和BTB-T组（13.2％）关于移植失败的差异无统计学意义（p = 0.38）。 32例（71％）患有股胫骨关节炎（IKDC C或D级）。 BTB组和BTB-T组在股内侧内侧骨关节炎方面没有差异。与BTB组（21％）和对侧膝关节（5％）相比，BTB-T组（59％）的外侧股骨骨关节炎明显增加。 36例（45％）患者接受了半月板外侧或内侧半月板切除术。平均主观IKDC评分为81.8 / 100，在BTB组和BTB-T组之间相当。 67％的人仍练习枢轴运动。结论在pa骨肌腱ACL成形术后19年的随访中，本研究未发现外侧腱膜明显改善移植物的存活率。外侧腱定病患者外侧股骨骨关节炎明显增加。但是，随访偏倚可能是在我们获得了X射线检查的BTB-T患者中，外侧半月板的病变更为常见。功能评分稳定在80/100以上，三分之二的患者仍在进行枢轴运动。在20年的随访中，ACL移植物存活率为80％。

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