Background:Bone–patellar tendon–bone (BPTB) and double-looped semitendinosus and gracilis (hamstring) grafts are commonly used for anterior cruciate ligament (ACL) reconstruction. Short-term and midterm studies show little or no differences between the 2 grafts; however, there are only a few long-term studies to compare results between the 2 grafts.Purpose:To compare the results after using either BPTB grafts or hamstring tendon grafts 18 years after ACL reconstruction.Study Design:Randomized controlled trial; Level of evidence 2.Methods:A total of 114 patients with ACL rupture between 2001 and 2004 were randomized to reconstruction with either a BPTB graft or a hamstring tendon graft. Patients were operated on at 4 major hospitals. The 18-year follow-up evaluation included anterior knee laxity measured with a KT-1000 arthrometer, defined as the primary outcome, while clinical examination (Lachman and pivot-shift tests), isokinetic testing of muscle strength, patient-reported outcome measures, and an assessment of radiographic osteoarthritis using the Kellgren-Lawrence classification were defined as secondary outcomes.Results:A total of 96 patients (84%, 47 BPTB and 49 hamstring grafts) were available for follow-up, 71 of these for clinical examination. Seven of 96 patients were excluded for ACL revision (n = 5) or knee replacement (n = 2) surgery. In total, 25 patients (10 BPTB and 15 hamstring grafts) had undergone additional surgery other than ACL revision or total knee arthroplasty. There were no significant differences between the groups in terms of anterior laxity test with KT-1000 arthrometer (primary outcome). In secondary outcomes, no significant differences between groups were reported regarding clinical examination, patient-reported outcome scores, or radiographic osteoarthritis (Kellgren-Lawrence grade 2-4 for patellofemoral joint [18 hamstring and 14 BPTB] or tibiofemoral joint [20 hamstring and 19 BPTB]), while isokinetic testing revealed that the hamstring group had a 10.7% reduction in mean peak flexion torque compared with the BPTB group at 60 deg/s ( df = 59; P = .011). At 60 deg/s the mean total flexion work in the hamstring group was reduced by 17.2% compared with the BPTB group ( df = 59; P = .002).Conclusion:The flexion strength in the hamstring group was significantly reduced in the operated knee after 18 years. There were no significant differences between the groups regarding subjective outcomes, patient-reported outcomes, range of motion, clinical and instrumented knee laxity, and the development of osteoarthritis.Registration:NCT05876013 (ClinicalTrials.gov identifier).

中文翻译：

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使用腘绳肌腱与髌腱重建 ACL 后 18 年后膝关节弯曲强度降低


背景：骨-髌腱-骨（BPTB）和双环半腱肌和股薄肌（腘绳肌）移植物通常用于前交叉韧带（ACL）重建。短期和中期研究表明两种移植物之间几乎没有差异；然而，只有少数长期研究来比较两种移植物之间的结果。目的：比较 ACL 重建后 18 年使用 BPTB 移植物或腘绳肌腱移植物的结果。研究设计：随机对照试验；证据级别 2.方法：2001年至2004年间共有114名ACL断裂患者被随机分配接受BPTB移植物或腘绳肌腱移植物重建。患者在4家主要医院接受了手术。 18 年的随访评估包括用 KT-1000 关节计测量的膝关节前松弛度（定义为主要结果），同时临床检查（拉赫曼和枢轴移位测试）、肌肉力量的等速测试、患者报告的结果测量、结果：共有 96 名患者（84%，47 名 BPTB 和 49 名腿筋移植患者）可进行随访，其中 71 名进行临床检查。 96 名患者中有 7 名被排除进行 ACL 翻修 (n = 5) 或膝关节置换 (n = 2) 手术。总共有 25 名患者（10 名 BPTB 和 15 名腿筋移植患者）接受了 ACL 翻修或全膝关节置换术以外的额外手术。使用 KT-1000 关节计进行的前部松弛测试（主要结果）在各组之间没有显着差异。 在次要结局中，在临床检查、患者报告的结局评分或放射学骨关节炎（髌股关节 [18 腿筋和 14 BPTB] 或胫股关节 [20 腿筋和 19] 的 Kellgren-Lawrence 2-4 级）方面，各组之间没有报告显着差异。 BPTB]），而等速测试显示，与 BPTB 组相比，在 60 度/秒时，腘绳肌组的平均峰值屈曲扭矩降低了 10.7%（df = 59；P = .011）。在 60 deg/s 时，与 BPTB 组相比，腘绳肌组的平均总屈曲功减少了 17.2%（df = 59；P = .002）。结论：手术中腘绳肌组的屈曲强度显着降低。 18年后膝盖。各组之间在主观结果、患者报告的结果、运动范围、临床和仪器膝关节松弛以及骨关节炎的发展方面没有显着差异。注册：NCT05876013（ClinicalTrials.gov 标识符）。