A semitendinosus with adjustable button graft construct in patients undergoing hamstring ACL reconstruction results in improved knee flexor strength symmetry and less donor site pain and morbidity: Outcomes from the DOSTAR randomized controlled trial.
Adam M Lawless, Jay R Ebert, Peter K Edwards, Shahbaz S Malik, Peter S E Davies, Peter A D'Alessandro
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引用次数: 0
Abstract
Purpose: To compare donor site morbidity and patient-reported outcome measures (PROMs), knee laxity and early strength and functional outcomes, following anterior cruciate ligament reconstruction (ACLR) using a semitendinosus (ST) tendon autograft with suspensory adjustable button tibial fixation or semitendinosus-gracilis (STG) autograft with tibial screw fixation.
Methods: While 153 patients were prospectively recruited and randomized to an ST or STG autograft, 131 (62 ST and 69 STG) were retained following ACLR and followed post-surgery. Standardized surgical techniques were employed, varying only in graft selection and fixation. The primary study outcomes were early hamstring pain, donor site morbidity and strength recovery. However, several outcomes were assessed pre-surgery and at 3 and 6 months, encompassing the Donor-site-related Functional Problems following Anterior Cruciate Ligament Reconstruction (DFPACLR) score, Visual Analogue Scale (VAS) for hamstring pain and other commonly employed PROMs, anteroposterior laxity (KT-1000), isokinetic hamstring and quadriceps strength, hop testing, complications and re-operations. Intention-to-treat analysis was performed using linear mixed models for continuous data and Mann-Whitney U tests where appropriate.
Results: At 6 months, ST patients reported significantly lower hamstring pain (p < 0.001) and DFPACLR (p < 0.001) scores. A significantly higher (p < 0.001) peak knee flexor strength limb symmetry index (LSI) was observed for the ST group, though no other group differences in side-to-side laxity, hop tests or other normalized strength measures or LSIs were observed.
Conclusions: ACLR using an ST autograft resulted in less donor site pain and morbidity, and improved knee flexor strength symmetry at 6 months, while demonstrating comparable functional outcomes to the STG autograft.
Level of evidence: Level 1 prospective, double-blinded, randomized controlled trial.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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