Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts A Prospective, Randomized Study

B. Beynnon, R. Johnson, B. Fleming, P. Kannus, M. Kaplan, J. Samani, P. Renström
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引用次数: 418

Abstract

Background: The purpose of this investigation was to evaluate replacement of a torn anterior cruciate ligament with either a bone-patellar tendon-bone autograft or a two-strand semitendinosus-gracilis autograft to compare the results of clinical testing, patient satisfaction, activity level, functional status, and muscle strength.Methods: Fifty-six patients with a torn anterior cruciate ligament were enrolled in a prospective, randomized, controlled study. Twenty-eight underwent reconstruction with a bone-patellar tendon-bone autograft, and twenty-eight were treated with a two-strand semitendinosus-gracilis autograft. Patients were followed for an average of thirty-nine months (range, thirty-six to fifty-seven months). At the time of final follow-up, twenty-two patients in each group were evaluated in terms of clinical test findings, patient satisfaction, activity level, functional status, and isokinetic muscle strength.Results: The objective outcome of replacement of the torn anterior cruciate ligament with a bone-patellar tendon-bone graft was superior to that obtained with a two-strand semitendinosus-gracilis graft. At the three-year follow-up interval, the patients in whom a hamstring graft had been used had an average of 4.4 mm of increased anterior knee laxity compared with the laxity of the contralateral, normal knee, whereas the patients in whom a bone-patellar tendon-bone graft had been used had an average of 1.1 mm of increased knee laxity. Fourteen percent (three) of the twenty-two patients with a hamstring graft had a mild pivot shift, and 27% (six) had a moderate pivot shift. Only 14% (three) of the twenty-two patients with a bone-patellar tendon-bone graft had a mild pivot shift, and none had a moderate pivot shift. At the same follow-up interval, the patients in whom a hamstring graft had been used had significantly lower peak knee-flexion strength than those who had a bone-patellar tendon-bone graft (p = 0.039). In contrast, the two treatments produced similar outcomes in terms of patient satisfaction, activity level, and knee function (ability to perform a one-legged hop, bear weight, squat, climb stairs, run in place, and duckwalk).Conclusions: After three years of follow-up, the objective results of anterior cruciate ligament replacement with a bone-patellar tendon-bone autograft were superior to those of replacement with a two-strand semitendinosus-gracilis graft with regard to knee laxity, pivot-shift grade, and strength of the knee flexor muscles. However, the two groups had comparable results in terms of patient satisfaction, activity level, and knee function.
前交叉韧带置换术:骨-髌骨肌腱-骨移植物与双股腿筋移植物的比较:一项前瞻性随机研究
背景:本研究的目的是评估用骨-髌骨肌腱-骨自体移植物或双股半腱肌-股薄肌自体移植物替代撕裂的前交叉韧带,比较临床试验结果、患者满意度、活动水平、功能状态和肌肉力量。方法:56例前十字韧带撕裂患者被纳入一项前瞻性、随机、对照研究。28例接受骨-髌骨肌腱-骨自体移植物重建,28例接受双股半腱肌-股薄肌自体移植物治疗。患者的平均随访时间为39个月(36至57个月)。在最后随访时,对每组22例患者的临床试验结果、患者满意度、活动水平、功能状态和等速肌力进行评估。结果:骨-髌骨肌腱-骨移植置换撕裂的前交叉韧带的客观疗效优于双股半腱肌-股薄肌移植。在三年的随访期间,与对侧正常膝关节的松弛度相比,使用腘绳肌腱移植的患者膝关节前侧松弛度平均增加4.4 mm,而使用骨-髌骨肌腱-骨移植的患者膝关节松弛度平均增加1.1 mm。22例腘绳肌腱移植患者中14%(3例)有轻度枢轴移位,27%(6例)有中度枢轴移位。22例骨-髌骨-肌腱-骨移植患者中只有14%(3例)发生轻度枢轴移位,没有一例发生中度枢轴移位。在相同的随访时间内,使用腘绳肌腱移植物的患者膝关节屈曲强度峰值明显低于骨-髌腱-骨移植物患者(p = 0.039)。相比之下,两种治疗方法在患者满意度、活动水平和膝关节功能(单腿跳跃、负重、下蹲、爬楼梯、原地跑步和鸭走的能力)方面产生了相似的结果。结论:经过三年的随访,自体骨-髌腱-骨移植替代前交叉韧带的客观结果优于双股半腱肌-股薄肌移植,在膝关节松松度、枢轴移位等级和膝关节屈肌力量方面。然而,两组在患者满意度、活动水平和膝关节功能方面具有可比性。
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