Autologous patellar tendon and quadrupled hamstring grafts in anterior cruciate ligament reconstruction: a prospective randomized multicenter review of different fixation methods

被引:72
作者
Drogset, Jon Olav [1 ]
Strand, Torbjorn [2 ]
Uppheim, Gisle [3 ]
Odegard, Bjorn [3 ]
Boe, Asbjorn [4 ]
Grontvedt, Torbjorn [5 ]
机构
[1] St Olavs Hosp, Dept Orthopaed, N-7006 Trondheim, Norway
[2] Bergen Deaconal Hosp, Dept Orthopaed, Bergen, Norway
[3] Lovisenberg Diakonale Hosp, Dept Orthopaed, Oslo, Norway
[4] Bergen Spine Ctr, Bergen, Norway
[5] Rosenborg Clin, Trondheim, Norway
关键词
Patellar tendon graft; Hamstring tendon graft; RCT; Anterior cruciate ligament/injuries/surgery; Prospective Studies; Treatment Outcome; Randomized; FOLLOW-UP; ARTHROSCOPIC RECONSTRUCTION; ACL RECONSTRUCTION; BONE-GRAFTS; ACCELERATED REHABILITATION; NONOPERATIVE TREATMENT; GRACILIS TENDON; SEMITENDINOSUS; AUTOGRAFTS; KNEE;
D O I
10.1007/s00167-009-0996-5
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
100224 [整形外科学];
摘要
ACL reconstruction with bone patellar tendon bone (BPTB) grafts has been shown to produce dependable results. Recently, reconstructions with double-looped semitendinosus gracilis (DLSG) grafts have become common. The prevailing opinion is that ACL reconstruction with patellar tendon graft produces a more stable knee with more anterior knee pain than DLSG grafts, while the functional results and knee scores are similar. The present study evaluates BPTB grafts fixed with metallic interference screws and DLSG grafts fixed with Bone Mulch Screw on the femur and WasherLoc fixation on the tibia. All else being the same, there is no difference in the outcome between the two grafts and fixation methods. This is a prospective randomized multicenter study. A total of 115 patients with isolated ACL ruptures were randomized to either reconstruction with BPTB grafts fixed with metal interference screws (58 patients) or DLSG grafts (57 patients) fixed with Bone Mulch Screws and WasherLoc Screws. Follow-up was at one and two years; the latter by an independent observer. At two years, one ACL revision had been performed in each group. Eight patients in the DLSG group and one in the BPTB group underwent meniscus surgery in the follow-up period (P = 0.014). Mean Lysholm score at the two year follow-up was 91 (SD +/- A 10.3) in the DLSG group and also 91 (SD +/- A 10.2) in the BPTB group. Mean KT-1000 at two years was 1.5 mm in the BPTB group and 1.8 mm in the DLSG group (n.s.). At two years, four patients in the BPTB group and three in the DLSG group had a Lachman test grade 2 or 3 (n.s.). More patients in the BPTB group had pain at the lower pole of the patella (P = 0.04). Peak flexion torque and total flexion work were lower in the DLSG group at one year (P = 0.003 and P = 0.000) and total flexion work also at two years (P = 0.05). BPTB ACL reconstruction fixed with interference screws and DLSG fixed with Bone Mulch Screws on the femur and WasherLoc Screws on the tibia produce satisfactory and nearly identical outcomes. Among our patients in the DLSG group, flexion strength was lower, and more patients underwent meniscus surgery in the follow-up period. The BPTB group has more anterior knee pain.
引用
收藏
页码:1085 / 1093
页数:9
相关论文
共 60 条
[1]
Anterior cruciate ligament reconstruction: Bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts - A prospective, randomized clinical trial [J].
Aglietti, P ;
Giron, F ;
Buzzi, R ;
Biddau, F ;
Sasso, F .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2004, 86A (10) :2143-2155
[2]
PATELLAR TENDON VERSUS DOUBLED SEMITENDINOSUS AND GRACILIS TENDONS FOR ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION [J].
AGLIETTI, P ;
BUZZI, R ;
ZACCHEROTTI, G ;
DEBIASE, P .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1994, 22 (02) :211-218
[3]
AGLIETTI P, 1994, CLIN ORTHOP RELAT R, P165
[4]
Correlation of anthropometric measurements, strength, anterior cruciate ligament size, and intercondylar notch characteristics to sex differences in anterior cruciate ligament tear rates [J].
Anderson, AF ;
Dome, DC ;
Gautam, S ;
Awh, MH ;
Rennirt, GW .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2001, 29 (01) :58-66
[5]
Arnold J A, 1979, Am J Sports Med, V7, P305, DOI 10.1177/036354657900700601
[6]
Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction - A randomized study with two-year follow-up [J].
Aune, AK ;
Holm, I ;
Risberg, MA ;
Jensen, HK ;
Steen, H .
AMERICAN JOURNAL OF SPORTS MEDICINE, 2001, 29 (06) :722-728
[7]
Barber FA, 2000, BIOMATERIALS, V21, P2623
[8]
Anterior cruciate ligament replacement: Comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts - A prospective, randomized study [J].
Beynnon, BD ;
Johnson, RJ ;
Fleming, BC ;
Kannus, P ;
Kaplan, M ;
Samani, J ;
Renstrom, P .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 2002, 84A (09) :1503-1513
[9]
MENISCAL LESIONS AND CHRONIC ANTERIOR CRUCIATE LIGAMENT DEFICIENCY - MENISCAL TEARS OCCURRING BEFORE AND AFTER RECONSTRUCTION [J].
BRAY, RC ;
DANDY, DJ .
JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 1989, 71 (01) :128-130
[10]
NONOPERATIVE TREATMENT OF ACUTE ANTERIOR CRUCIATE LIGAMENT INJURIES IN A SELECTED GROUP OF PATIENTS [J].
BUSS, DD ;
MIN, R ;
SKYHAR, M ;
GALINAT, B ;
WARREN, RF ;
WICKIEWICZ, TL .
AMERICAN JOURNAL OF SPORTS MEDICINE, 1995, 23 (02) :160-165