膝蓋或膕旁肌腱ACL修復結果相似


  July 24, 2003 -膝蓋或膕旁肌腱前面十字繫帶(ACL) 修復的結果基本上是一樣的,但是前者會增加痛苦而後者膝蓋鬆弛的情況會增加,這項前瞻性隨機試驗研究結果刊載於July/August期的American Journal of Sports Medicine,研究人員提供了選擇處置的建議。
  
  澳大利亞La Trobe大學肌肉與骨骼研究中心的Julian A. Feller, FRACS, and Kate E. Webster, PhD表示,膝蓋和膕旁肌腱自體移植物是重建最常使用的移植類型,但是很少有研究較直接比較結果。
  
  單獨ACL破裂後,共有65個病人接受膝蓋肌腱或4股膕旁肌腱移植重建,平均追蹤隨訪36個月,這兩組病人Cincinnati膝蓋評分、International Knee Documentation Committee評分或恢復受傷前活動水平等方面沒有明顯不同。
  
  膝蓋肌腱組在四個月和八個月的時候,病人如果做跪下的動作,疼痛更為明顯、伸展不足的情況也更多,四頭肌peak torque不足較多,但是隨後的情形好轉,膕旁肌腱組8個月和24個月的時候,活動靈活性不足的病人更多,前面膝蓋鬆弛KT-1000體節side-to-side 差異也更多見。
  
  作者寫到,兩組移植都具有令人滿意的功能結果,但是膝蓋肌腱組病人不健全增加、膕旁肌腱組膝蓋鬆弛增加且股骨隧道變寬,膕旁肌腱移植在開放生長plates的位置較好,而bone-patellar tendon-bone移植在較鬆的膝蓋更適合,而病人主要運動項目的性質也是選擇移植方式的重要因素。

Outcomes Similar for Patellar<

By Laurie Barclay, MD
Medscape Medical News

July 24, 2003 — Outcomes are essentially the same for patellar tendon and hamstring tendon anterior cruciate ligament (ACL) repair, except that the former is associated with increased pain and the latter with increased knee laxity, according to the results of a prospective randomized trial published in the July/August issue of the American Journal of Sports Medicine. The investigators offer suggestions for deciding which procedure to use.

"Patellar and hamstring tendon autografts are the most frequently used graft types for reconstruction, but few direct comparisons of outcomes have been published," write Julian A. Feller, FRACS, and Kate E. Webster, PhD, from La Trobe University Musculoskeletal Research Centre in Melbourne, Australia.

After isolated ACL rupture, 65 patients received either a patellar tendon or a four-strand hamstring tendon graft reconstruction and were followed for 36 months. The two groups did not differ significantly in Cincinnati knee scores, International Knee Documentation Committee ratings, or rates of return to preinjury activity levels.

In the patellar tendon group, pain on kneeling was more common, extension deficits were greater, and there were greater quadriceps peak torque deficits at 4 and 8 months but not subsequently. The hamstring tendon group had greater active flexion deficits from 8 to 24 months and greater KT-1000 arthrometer side-to-side differences in anterior knee laxity at 134 N (30 lb).

"Both grafts resulted in satisfactory functional outcomes but with increased morbidity in the patellar tendon group and increased knee laxity and radiographic femoral tunnel widening in the hamstring tendon group," the authors write. "Hamstring tendon grafts are preferable in the setting of open growth plates, whereas a bone-patellar tendon-bone graft may be more appropriate in a 'loose' knee. The nature of the primary sport played by the patient may also be important in selecting the appropriate graft."

Am J Sports Med. 2003;31:564-573

Reviewed by Gary D. Vogin, MD

    
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