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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >SEX, PATELLAR TENDON GRAFT, AND EARLY MOTION DEFICITS PREDICT ARTHROFIBROSIS AFTER PEDIATRIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
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SEX, PATELLAR TENDON GRAFT, AND EARLY MOTION DEFICITS PREDICT ARTHROFIBROSIS AFTER PEDIATRIC ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

机译：性，髌骨肌腱移植和早期运动缺陷预测儿科前十字韧带重建后的节点纤维化

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Background: Arthrofibrosis remains a concerning early complication after anterior cruciate ligament reconstruction (ACLR) in children and adolescents. Previous studies suggest that those receiving patellar tendon (PT) autograft may be at higher risk than hamstrings tendon (HT), but there is little data regarding this complication in patients receiving quadriceps tendon (QT) autograft. Purpose: The purpose of this study is to identify risk factors for arthrofibrosis following pediatric ACLR with attention to graft type. Methods: The medical records of patients that underwent primary ACLR at a single tertiary children’s hospital were reviewed for this retrospective cohort study. Those with multiligament reconstructions, lateral extra-articular tenodesis procedures, or a modified MacIntosh reconstruction were excluded. Arthrofibrosis was defined as a deficit of 10 degrees of extension and/or 20 degrees of flexion at 3 months after ACLR. Demographic data, intra-operative findings and techniques, and post-operative motion and complications were recorded. Univariate analysis was followed by purposeful entry logistic regression to control for confounding factors. Results: A total of 378 patients were included in the analysis, of which there were 180 PT, 103 HT, and 95 QT grafts. The mean age was 15.9±1.7 years and 188 (49.7%) were female. In univariate analysis, the rate of arthrofibrosis was 1.9% for HT, 6.3% for QT, and 10.0% for PT (p=0.04). Females developed arthrofibrosis more frequently than males (10.6% vs. 3.2%, p=0.004). Additionally, those that ultimately experienced this complication had lower median flexion at 6 weeks after ACLR (88 vs. 110 degrees, p&0.001). After controlling for covariates in a multivariate model, PT graft raised the odds of arthrofibrosis 6.2 times compared to HT (95% CI 1.4-27.6, p=0.02), but there were no significant differences between QT and other graft types. Females were at 4.2 times higher odds than males (95% CI 1.6-10.8; p=0.003). Patients that were unable to attain 90 degrees of flexion 6 weeks after ACLR had 14.7 times higher odds of eventually developing arthrofibrosis (95% CI 5.4-39.8; p&0.001). Finally, those with an extension deficit of ≥5 degrees 6 weeks after ACLR had 4.7 times higher odds of experiencing this complication (95% CI 1.8-12.2, p=0.001). Conclusion: After adjusting for multiple covariates, PT autograft, female sex, and motion deficits at 6 weeks after ACLR (&90 degrees of flexion or extension deficit ≥5 degrees) were predictive of arthrofibrosis in children and adolescents. Quadriceps tendon autograft did not increase the risk of this complication.
机译：背景：促使节点纤维化仍然是在儿童和青少年前十字韧带重建（ACLR）后的早期并发症。以前的研究表明，接受髌骨肌腱（PT）自体移植的人可能比腿段肌腱（HT）更高，但是患有QuadRiceps肌腱（QT）自体移植患者的这种并发症几乎没有数据。目的：本研究的目的是识别儿科ACLR后关节纤维化的危险因素，注意移植型。方法：对这个回顾性的队列研究进行了审查了在单一三级儿童医院接受过一次ACLR的患者的病程。具有多重重建，横向特关节性成本组织或改进的Macintosh重建的那些。关节纤维化定义为ACLR后3个月的10°延伸和/或20度屈曲的缺陷。记录了人口统计数据，术中的操作结果和技术以及操作后运动和并发症。单变量分析随后是有目的的入门物流回归来控制混杂因素。结果：分析中共有378名患者，其中有180pt，103 ht和95 Qt移植物。平均年龄为15.9±1.7岁，188名（49.7％）是女性。在单变量分析中，QT的HT，6.3％的促纤维化率为1.9％，Pt为10.0％（P = 0.04）。女性比男性更频繁地开发了节点刺激（10.6％对3.2％，p = 0.004）。此外，最终经历这种并发症的那些在ACLR（88 vs.110度，P＆amp; 0.001）后6周的中位数屈曲较低。在控制多元模型中的协变量之后，PT移植物升高了与HT（95％CI 1.4-27.6，P = 0.02）相比的节肢动物的几率6.2次，但QT和其他接枝类型之间没有显着差异。女性比男性高出4.2倍，少于男性（95％CI 1.6-10.8; p = 0.003）。在ACLR后6周内无法获得90度屈曲的患者的最终发育促纤维化的次数较高14.7倍（95％CI 5.4-39.8; P＆amp; 0.001）。最后，在ACLR后6周后延伸赤字的延长率≥5度的人在经历这种并发症的几率越高4.7倍（95％CI 1.8-12.2，P = 0.001）。结论：在ACLR（＆amp; LT; LT; LT; LT; LT; 90度屈曲或延伸赤字≥5度）的6周调整多次协变量，PT自体移植，女性和运动缺陷后。 Quadriceps肌腱自体移植物质没有增加这种并发症的风险。

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