关节镜下自体或同种异体肌腱移植修复急性和陈旧性前交叉韧带损伤:重建效果评价
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摘要
背景:关节镜自体肌腱与异体肌腱治疗前交叉韧带急性损伤和陈旧性损伤的效果尚需证实。目的:关节镜下采用自体肌腱或同种异体肌腱对前交叉韧带急性损伤或陈旧性损伤的患者进行重建,评估重建后的效果,并对重建时间与内植物材料的选择进行临床效果分析。方法:对前交叉韧带重建的患者105例进行随访。根据患者韧带损伤时间与采用的内植物不同分成4组:急性自体组25例为急性损伤+自体肌腱移植;急性异体组7例为急性损伤+同种异体肌腱移植;陈旧自体组55例为陈旧性损伤+自体肌腱移植;陈旧异体组,18例为陈旧性损伤+同种异体肌腱移植。术前后采用Lysholm膝关节功能评分表对膝关节功能进行评分,术后随访70个月。结果与结论:(1)膝关节功能:与术前相比,术后70个月4组Lysholm评分均升高(P<0.05);(2)进一步做各因素的单独效应分析:急性损伤时,使用自体肌腱的Lysholm评分高于同种异体肌腱(P<0.05);(3)结果表明,在前交叉韧带损伤时,应早期在关节镜下使用自体肌腱进行重建,有利于膝关节功能更好恢复。
BACKGROUND: Therapeutic efficacy on acute and old injuries of the anterior cruciate ligament treated with arthroscopic autologous or allogenic tendon has not yet been well studied. OBJECTIVE: To analyze the effect of arthroscopic reconstruction for acute and chronic anterior cruciate ligament injury using autologous or allogeneic tendon graft, and to discuss the clinical effectiveness of different implantmaterials at different reconstruction time. METHODS: We collected 105 patients who received arthroscopic reconstruction for anterior cruciate ligament injury, and divided them into four groups according to different injury time and implant materials: acute autograft group(acute injury+autologous tendon, 25 cases); acute allograft group(acute injury+allogeneic tendon, 7 cases); old autograft group(old injury+autologous tendon, 55 cases); old allograft group(old injury+ allogeneic tendon, 18 cases). Lysholm scores were used to test patient's knee function before and after surgery. The follow-up time was 70 months RESULTS AND CONCLUSION: There was a significant improvement in the knee function at 70 months after surgery, and the Lysholm scores of each patient was significantly increased as compared with the baseline(P < 0.05). We did the further analysis of single factor effects and found that the Lysholm score in the acute autograft group was significantly high than that in the acute allograft group(P < 0.05). Therefore, early reconstruction using arthroscopic autologous tendon is of clinical benefit for anterior cruciate ligament injuries to restore the knee function.
BACKGROUND: Therapeutic efficacy on acute and old injuries of the anterior cruciate ligament treated with arthroscopic autologous or allogenic tendon has not yet been well studied. OBJECTIVE: To analyze the effect of arthroscopic reconstruction for acute and chronic anterior cruciate ligament injury using autologous or allogeneic tendon graft, and to discuss the clinical effectiveness of different implantmaterials at different reconstruction time. METHODS: We collected 105 patients who received arthroscopic reconstruction for anterior cruciate ligament injury, and divided them into four groups according to different injury time and implant materials: acute autograft group(acute injury+autologous tendon, 25 cases); acute allograft group(acute injury+allogeneic tendon, 7 cases); old autograft group(old injury+autologous tendon, 55 cases); old allograft group(old injury+ allogeneic tendon, 18 cases). Lysholm scores were used to test patient's knee function before and after surgery. The follow-up time was 70 months RESULTS AND CONCLUSION: There was a significant improvement in the knee function at 70 months after surgery, and the Lysholm scores of each patient was significantly increased as compared with the baseline(P < 0.05). We did the further analysis of single factor effects and found that the Lysholm score in the acute autograft group was significantly high than that in the acute allograft group(P < 0.05). Therefore, early reconstruction using arthroscopic autologous tendon is of clinical benefit for anterior cruciate ligament injuries to restore the knee function.
引文
[1]Hurd WJ,Axe MJ,Snyder-Mackler L.Influence of age,gender,and injury mechanism on the development of dynamic knee stability after acute ACL rupture.J Orthop Sports Phys Ther.2008;38(2):36-41.
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[5]Li B,Bai L,Fu Y,et al.Effect of timing of surgery in partially injured ACLs.Orthopedics.2012;35(5):408-412.
[6]Herbst E,Hoser C,Gfoller P,et al.Impact of surgical timing on the outcome of anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc.2017;25(2):569-577.
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[9]Kwok CS,Harrison T,Servant C.The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness.Arthroscopy.2013;29(3):556-565.
[10]Krutsch W,Zellner J,Baumann F,et al.Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology.Knee Surg Sports Traumatol Arthrosc.2017;25(2):418-425.
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[13]Andernord D,Karlsson J,Musahl V,et al.Timing of surgery of the anterior cruciate ligament.Arthroscopy.2013;29(11):1863-1871.
[14]Chong RW,Tan JL.Rising trend of anterior cruciate ligament injuries in females in a regional hospital.Ann Acad Med Singapore.2004;33(3):298-301.
[15]Kaeding CC,Aros B,Pedroza A,et al.Allograft versus autograft anterior cruciate ligament reconstruction:predictors of failure from a moon prospective longitudinal cohort.Sports Health.2011;3(1):73-81.
[16]Rice RS,Waterman BR,Lubowitz JH.Allograft versus autograft decision for anterior cruciate ligament reconstruction:an expected-value decision analysis evaluating hypothetical patients.Arthroscopy.2012;28(4):539-547.
[17]Hu J,Qu J,Xu D et al.Allograft versus autograft for anterior cruciate ligament reconstruction:an up-to-date meta-analysis of prospective studies.Int Orthop.2013;37(2):311-320.
[18]Aslan A,Ozer O,Baydar ML,et al.Anterior cruciate ligament injuries:does surgical treatment with autograft versus allograft option affect the clinical results?Ulus Travma Acil Cerrahi Derg.2012;18(2):153-161.
[19]Paschos NK,Howell SM.Anterior cruciate ligament reconstruction:principles of treatment.EFORT Open Reviews.2016;1(11):398-408.
[20]Kane PW,Wascher J,Dodson CC,et al.Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft in skeletally mature patients aged 25years or younger.Knee Surg Sports Traumatol Arthrosc.2016;24(11):3627-3633.
[21]Sun K,Zhang J,Wang Y,et al.Arthroscopic anterior cruciate ligament reconstruction with at least 2.5 years’follow-up comparing hamstring tendon autograft and irradiated allograft.Arthroscopy.2011;27(9):1195-1202.
[22]Islam MZ,Rahman M,Ali ME,et al.Arthroscopic anterior cruciate ligament reconstruction with triplet autograft of semitendinosus tendon.Mymensingh Med J.2017;26(3):545-550.
[23]Wasserstein D,Sheth U,Cabrera A,et al.A systematic review of failed anterior cruciate ligament reconstruction with autograft compared with allograft in young patients.Sports Health.2015;7(3):207-216.
[24]Barrera Oro F,Sikka R,Wolters B,et al.Autograft versus allograft:an economic cost comparison of anterior cruciate ligament reconstruction.Arthroscopy.2011;27(9):1219-1225.
[25]Bottoni CR,Smith EL,Shaha J,et al.Autograft versus allograft anterior cruciate ligament reconstruction:a prospective,randomized clinical study with a minimum10-year follow-up.Am J Sports Med.2015;43(10):2501-2509.
[26]Zeng C,Gao S,Li H,et al.Autograft versus allograft in anterior cruciate ligament reconstruction:a meta-analysis of randomized controlled trials and systematic review of overlapping systematic reviews.Arthroscopy.2016;32(1):153-163.
[27]Mariscalco MW,Magnussen RA,Mehta D,et al.Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction:a systematic review.Am J Sports Med.2014;42(2):492-499.
[28]Engelman GH,Carry PM,Hitt KG,et al.Comparison of allograft versus autograft anterior cruciate ligament reconstruction graft survival in an active adolescent cohort.Am J Sports Med.2014;42(10):2311-2318.
[29]Jia YH,Sun PF.Comparison of Clinical Outcome of Autograft and Allograft Reconstruction for Anterior Cruciate Ligament Tears.Chin Med J.2015;128(23):3163-3166.
[30]Yang R,Deng H,Hou J,et al.Comparison of Knee Stability and Synovial Fluid Alterations in Anterior Cruciate Ligament Reconstruction With a Hamstring Autograft or an Allograft.Orthopedics.2017;40(15):e892-e897.
[31]Cooper MT,Kaeding C.Comparison of the hospital cost of autograft versus allograft soft-tissue anterior cruciate ligament reconstructions.Arthroscopy.2010;26(11):1478–1482.
[32]Cvetanovich GL,Mascarenhas R,Saccomanno MF,et al.Hamstring autograft versus soft-tissue allograft in anterior cruciate ligament reconstruction:a systematic review and meta-analysis of randomized controlled trials.Arthroscopy.2014;30(12):1616-1624.
[33]Mascarenhas R,Erickson BJ,Sayegh ET,et al.Is there a higher failure rate of allografts compared with autografts in anterior cruciate ligament reconstruction:a systematic review of overlapping meta-analyses.Arthroscopy.2015;31(2):364-372.
[34]Noyes FR,Barber-Westin SD.Posterior cruciate ligament allograft reconstruction with and without a ligament augmentation device.Arthroscopy.1994;10(4):371-382.
[35]冯华,洪雷,耿向苏,等.前十字韧带损伤合并内侧半月板ramp损伤[J].中华骨科杂志,2005,25(11):651-655.
[36]Mccarthy M,Mallett K,Abola M,et al.Hospital for special surgery ACL registry:2-year outcomes suggest low revision and return to OR rates.HSS J.2017;13(2):119-127.
[37]SklenskyJ,Vali?P,Repko M,et al.The Use of BTB Allograft in Revision Reconstruction of the Anterior Cruciate Ligament and Its Success Rate in Terms of Subjective Patient Satisfaction.Acta Chir Orthop Traumatol Cech.2017;84(2):106-113.
[38]Catterall JB,Stabler TV,Flannery CR,et al.Changes in serum and synovial fluid biomarkers after acute injury(NCT00332254).Arthritis Res Ther.2010;12(6):R229.
[39]林子洪,傅明,康焱,等.前交叉韧带切除后股骨关节软骨变化的初步实验研究[J].中华关节外科杂志(电子版),2008,2(5):554-565.
[40]Jackson DW,Corsetti J,Simon T M.Biologic incorporation of allograft anterior cruciate ligament replacements.Clin Orthop Relat Res.1996;(324):126-133.
[41]Malinin TI,Levitt RL,Bashore C.A study of retrieved allografts used to replace anterior cruciate ligaments.Arthroscopy.2002;18(2):163-170.
[42]Jaureguito JW,Paulos LE.Why grafts fail.Clin Orthop Relat Res.1996;(325):25-41.
[2]Renstrom P,Ljungqvist A,Arendt E,et al.Non-contact ACL injuries in female athletes:an International Olympic Committee current concepts statement.Br J Sports Med.2008;42(6):394-412.
[3]Anderson AF,Anderson CN.Correlation of meniscal and articular cartilage injuries in children and adolescents with timing of anterior cruciate ligament reconstruction.Am J Sports Med.2015;43(2):275-281.
[4]Anstey DE,Heyworth BE,Price MD,et al.Effect of timing of ACL reconstruction in surgery and development of meniscal and chondral lesions.Phys Sports Med.2012;40(1):36-40.
[5]Li B,Bai L,Fu Y,et al.Effect of timing of surgery in partially injured ACLs.Orthopedics.2012;35(5):408-412.
[6]Herbst E,Hoser C,Gfoller P,et al.Impact of surgical timing on the outcome of anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc.2017;25(2):569-577.
[7]Mook WR,Miller MD,Diduch DR,et al.Multiple-ligament knee injuries:a systematic review of the timing of operative intervention and postoperative rehabilitation.J Bone Joint Surg Am.2009;91(12):2946-2957.
[8]Brambilla L,Pulici L,Carimati,et al.Prevalence of associated lesions in anterior cruciate ligament reconstruction:correlation with surgical timing and with patient age,sex,and body mass index.Am J Sports Med.2015;43(12):2966-2973.
[9]Kwok CS,Harrison T,Servant C.The optimal timing for anterior cruciate ligament reconstruction with respect to the risk of postoperative stiffness.Arthroscopy.2013;29(3):556-565.
[10]Krutsch W,Zellner J,Baumann F,et al.Timing of anterior cruciate ligament reconstruction within the first year after trauma and its influence on treatment of cartilage and meniscus pathology.Knee Surg Sports Traumatol Arthrosc.2017;25(2):418-425.
[11]Camp CL,Lebaschi A,Cong GT,et al.Timing of postoperative mechanical loading affects healing following anterior cruciate ligament reconstruction:analysis in a murine model.J Bone Joint Surg Am.2017;99(16):1382-1391.
[12]Kennedy J,Jackson MP,O'Kelly P,et al.Timing of reconstruction of the anterior cruciate ligament in athletes and the incidence of secondary pathology within the knee.J Bone Joint Surg Br.2010;92(3):362-366.
[13]Andernord D,Karlsson J,Musahl V,et al.Timing of surgery of the anterior cruciate ligament.Arthroscopy.2013;29(11):1863-1871.
[14]Chong RW,Tan JL.Rising trend of anterior cruciate ligament injuries in females in a regional hospital.Ann Acad Med Singapore.2004;33(3):298-301.
[15]Kaeding CC,Aros B,Pedroza A,et al.Allograft versus autograft anterior cruciate ligament reconstruction:predictors of failure from a moon prospective longitudinal cohort.Sports Health.2011;3(1):73-81.
[16]Rice RS,Waterman BR,Lubowitz JH.Allograft versus autograft decision for anterior cruciate ligament reconstruction:an expected-value decision analysis evaluating hypothetical patients.Arthroscopy.2012;28(4):539-547.
[17]Hu J,Qu J,Xu D et al.Allograft versus autograft for anterior cruciate ligament reconstruction:an up-to-date meta-analysis of prospective studies.Int Orthop.2013;37(2):311-320.
[18]Aslan A,Ozer O,Baydar ML,et al.Anterior cruciate ligament injuries:does surgical treatment with autograft versus allograft option affect the clinical results?Ulus Travma Acil Cerrahi Derg.2012;18(2):153-161.
[19]Paschos NK,Howell SM.Anterior cruciate ligament reconstruction:principles of treatment.EFORT Open Reviews.2016;1(11):398-408.
[20]Kane PW,Wascher J,Dodson CC,et al.Anterior cruciate ligament reconstruction with bone-patellar tendon-bone autograft versus allograft in skeletally mature patients aged 25years or younger.Knee Surg Sports Traumatol Arthrosc.2016;24(11):3627-3633.
[21]Sun K,Zhang J,Wang Y,et al.Arthroscopic anterior cruciate ligament reconstruction with at least 2.5 years’follow-up comparing hamstring tendon autograft and irradiated allograft.Arthroscopy.2011;27(9):1195-1202.
[22]Islam MZ,Rahman M,Ali ME,et al.Arthroscopic anterior cruciate ligament reconstruction with triplet autograft of semitendinosus tendon.Mymensingh Med J.2017;26(3):545-550.
[23]Wasserstein D,Sheth U,Cabrera A,et al.A systematic review of failed anterior cruciate ligament reconstruction with autograft compared with allograft in young patients.Sports Health.2015;7(3):207-216.
[24]Barrera Oro F,Sikka R,Wolters B,et al.Autograft versus allograft:an economic cost comparison of anterior cruciate ligament reconstruction.Arthroscopy.2011;27(9):1219-1225.
[25]Bottoni CR,Smith EL,Shaha J,et al.Autograft versus allograft anterior cruciate ligament reconstruction:a prospective,randomized clinical study with a minimum10-year follow-up.Am J Sports Med.2015;43(10):2501-2509.
[26]Zeng C,Gao S,Li H,et al.Autograft versus allograft in anterior cruciate ligament reconstruction:a meta-analysis of randomized controlled trials and systematic review of overlapping systematic reviews.Arthroscopy.2016;32(1):153-163.
[27]Mariscalco MW,Magnussen RA,Mehta D,et al.Autograft versus nonirradiated allograft tissue for anterior cruciate ligament reconstruction:a systematic review.Am J Sports Med.2014;42(2):492-499.
[28]Engelman GH,Carry PM,Hitt KG,et al.Comparison of allograft versus autograft anterior cruciate ligament reconstruction graft survival in an active adolescent cohort.Am J Sports Med.2014;42(10):2311-2318.
[29]Jia YH,Sun PF.Comparison of Clinical Outcome of Autograft and Allograft Reconstruction for Anterior Cruciate Ligament Tears.Chin Med J.2015;128(23):3163-3166.
[30]Yang R,Deng H,Hou J,et al.Comparison of Knee Stability and Synovial Fluid Alterations in Anterior Cruciate Ligament Reconstruction With a Hamstring Autograft or an Allograft.Orthopedics.2017;40(15):e892-e897.
[31]Cooper MT,Kaeding C.Comparison of the hospital cost of autograft versus allograft soft-tissue anterior cruciate ligament reconstructions.Arthroscopy.2010;26(11):1478–1482.
[32]Cvetanovich GL,Mascarenhas R,Saccomanno MF,et al.Hamstring autograft versus soft-tissue allograft in anterior cruciate ligament reconstruction:a systematic review and meta-analysis of randomized controlled trials.Arthroscopy.2014;30(12):1616-1624.
[33]Mascarenhas R,Erickson BJ,Sayegh ET,et al.Is there a higher failure rate of allografts compared with autografts in anterior cruciate ligament reconstruction:a systematic review of overlapping meta-analyses.Arthroscopy.2015;31(2):364-372.
[34]Noyes FR,Barber-Westin SD.Posterior cruciate ligament allograft reconstruction with and without a ligament augmentation device.Arthroscopy.1994;10(4):371-382.
[35]冯华,洪雷,耿向苏,等.前十字韧带损伤合并内侧半月板ramp损伤[J].中华骨科杂志,2005,25(11):651-655.
[36]Mccarthy M,Mallett K,Abola M,et al.Hospital for special surgery ACL registry:2-year outcomes suggest low revision and return to OR rates.HSS J.2017;13(2):119-127.
[37]SklenskyJ,Vali?P,Repko M,et al.The Use of BTB Allograft in Revision Reconstruction of the Anterior Cruciate Ligament and Its Success Rate in Terms of Subjective Patient Satisfaction.Acta Chir Orthop Traumatol Cech.2017;84(2):106-113.
[38]Catterall JB,Stabler TV,Flannery CR,et al.Changes in serum and synovial fluid biomarkers after acute injury(NCT00332254).Arthritis Res Ther.2010;12(6):R229.
[39]林子洪,傅明,康焱,等.前交叉韧带切除后股骨关节软骨变化的初步实验研究[J].中华关节外科杂志(电子版),2008,2(5):554-565.
[40]Jackson DW,Corsetti J,Simon T M.Biologic incorporation of allograft anterior cruciate ligament replacements.Clin Orthop Relat Res.1996;(324):126-133.
[41]Malinin TI,Levitt RL,Bashore C.A study of retrieved allografts used to replace anterior cruciate ligaments.Arthroscopy.2002;18(2):163-170.
[42]Jaureguito JW,Paulos LE.Why grafts fail.Clin Orthop Relat Res.1996;(325):25-41.