使用 LARS 增强的自体腘绳肌进行双束前交叉韧带重建显示与单独腘绳肌相当的结果，没有滑膜炎或早期骨关节炎的证据,Knee Surgery, Sports Traumatology, Arthroscopy

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使用 LARS 增强的自体腘绳肌进行双束前交叉韧带重建显示与单独腘绳肌相当的结果，没有滑膜炎或早期骨关节炎的证据
Knee Surgery, Sports Traumatology, Arthroscopy ( IF 3.3 ) Pub Date : 2021-11-27 , DOI: 10.1007/s00167-021-06801-7
Jay R. Ebert , Robert Nairn , William Breidahl , Peter T. Annear

目的

比较接受或不接受 LARS 增强的前交叉韧带重建 (ACLR) 患者的临床和放射学结果。

方法

对136名接受双束ACLR 的患者进行了临床评估和磁共振成像（MRI ) 至少术后 7 年。通过患者报告的结果测量 (PROM)、KT-1000（松弛）、等速膝关节伸屈肌强度和 4 跳测试组对患者进行评估。计算肢体对称指数（LSI）。全器官磁共振成像评分 (WORMS) 通过 MRI 评估膝关节状态。报告了运动参与、二次手术、ACL 再撕裂和对侧 ACL 撕裂。

结果

在人口统计、PROM、KT-1000 分数或力量和跳跃 LSI 方面没有观察到差异 (ns)。分别在 64 名 (92.8%) 和 59 名 (88.1%) 的 DB Hams 和 DB Hams/LARS 患者中观察到正常（< 3 mm 左右差异）KT-1000 评分。报告了比较满意率。两组的膝屈肌力量和跳跃测试 LSI 均为 ˃95%，在 DB Hams 和 DB Hams/LARS 队列中，膝伸肌力量分别为 94.2% 和 96.7%。虽然 53 名 (76.8%) 和 52 名 (77.6%) 的 DB Hams 和 DB Hams/LARS 患者已经恢复了转体运动，但有 42 名 (60.9%) 和 41 名 (61.2%) 参加了至少 7 年的转体运动审查。在 WORMS (12.3 DB Hams, 16.7 DB Hams/LARS) 中没有观察到差异 (ns)。在评估的队列中，8 (11%) DB Hams 和 11 (16%) DB Hams/LARS 患者接受了二次手术。除了每组中的一名患者在 MRI 上显示 ACL 断裂外，由于先前的再撕裂，另外一组患者被排除在当前分析之外（DB Hamsn = 6，DB Hams/LARS n = 8）或对侧 ACL 撕裂（DB Hams n = 4，DB Hams/LARS n = 4）。

结论

在使用自体腘绳肌进行双束 ACLR 后观察到可比较的结果，无论是否使用 LARS 增强。因此，尽管鉴于缺乏进一步的益处和额外的成本，这些结果并不能证明额外使用合成增强是合理的，但没有观察到先前报道的更高的移植失败率、滑膜炎和早期骨关节炎改变。

证据水平

三、

"点击查看英文标题和摘要"

Double-bundle anterior cruciate ligament reconstruction using autologous hamstrings with LARS augmentation demonstrates comparable outcomes to hamstrings alone, without evidence of synovitis or early osteoarthritis

Purpose

To compare the clinical and radiological outcomes in patients undergoing anterior cruciate ligament reconstruction (ACLR) with, or without, LARS augmentation.

Methods

One-hundred and thirty-six patients that underwent double-bundle ACLR with (DB Hams/LARS, n = 67), or without (DB Hams, n = 69), LARS augmentation, were assessed clinically and with Magnetic Resonance Imaging (MRI) at a minimum of 7-years post-surgery. Patients were assessed via patient-reported outcome measures (PROMs), KT-1000 (laxity), isokinetic knee extensor and flexor strength and a 4-hop test battery. Limb symmetry indices (LSIs) were calculated. The Whole-Organ Magnetic Resonance Imaging Score (WORMS) evaluated knee status via MRI. Sport participation, secondary operations, ACL re-tears and contralateral ACL tears were reported.

Results

No differences (n.s.) were observed in demographics, PROMs, KT-1000 scores or strength and hop LSIs. Normal (< 3 mm side-to-side differences) KT-1000 scores were observed in 64 (92.8%) and 59 (88.1%) of DB Hams and DB Hams/LARS patients, respectively. Comparative rates of satisfaction were reported. Knee flexor strength and hop test LSIs were all ˃95% in both groups, which was 94.2% and 96.7% for knee extensor strength in the DB Hams and DB Hams/LARS cohorts, respectively. While 53 (76.8%) and 52 (77.6%) of the DB Hams and DB Hams/LARS patients had returned to pivoting sports, 42 (60.9%) and 41 (61.2%) were participating in pivoting sports at the minimum 7-year review. No difference (n.s.) was observed in the WORMS (12.3 DB Hams, 16.7 DB Hams/LARS). Of the cohort assessed, 8 (11%) DB Hams and 11 (16%) DB Hams/LARS patients had undergone secondary surgery. In addition to one patient in each group that demonstrated ACL rupture on MRI, an additional cohort of patients were excluded from the current analysis due to prior re-tear (DB Hams n = 6, DB Hams/LARS n = 8) or contralateral ACL tear (DB Hams n = 4, DB Hams/LARS n = 4).

Conclusions

Comparable outcomes were observed after double-bundle ACLR using autologous hamstrings with, or without, LARS augmentation. Therefore, while these outcomes do not justify the additional use of synthetic augmentation given the lack of further benefit and additional cost, higher rates of graft failure, synovitis and early osteoarthritic change previously reported were not observed.

Level of Evidence

III.

更新日期：2021-11-27

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