No difference in clinical outcome between quadriceps tendon anterior cruciate ligament reconstruction with and without bone block: Results from the Danish Knee Ligament Registry

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-09-20 DOI:10.1002/ksa.12451

Martin Lind, Torsten Nielsen

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Abstract

Purpose

The quadriceps tendon (QT) has recently gained increasing interest as an anterior cruciate ligament reconstruction (ACLR) graft due to minimally invasive harvesting techniques and low donor site morbidity. QT grafts can be used both with a patella bone block and as complete soft tissue grafts. However, it is unknown whether the QT graft type affects clinical outcomes. This study used data from the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates, knee stability and subjective clinical outcomes in patients who underwent ACLR with QT graft with bone block (QT-B) or soft tissue only (QT-S).

Methods

Patients who underwent primary ACL reconstruction with QT autografts documented in the DKRR were included and divided into the QT-B (n = 925) and QT-S (n = 659) groups. The clinical outcome was evaluated using objective-instrumented knee stability, pivot shift test, knee injury osteoarthritis outcome score (KOOS) and Tegner activity scores for the two cohorts performed at the 1-year follow-up. The overall revision rates were determined as well.

Results

Revision rates at 2 years were equally low in both graft groups at 2.8%. Similarly, post-operative knee laxity was equal at 1.5 (1.4) and 1.6 (1.4) mm side-to-side laxity, respectively. However, QT-B exhibited a reduced post-operative positive pivot shift of 22% compared with 31% for QT-S. Although the subjective outcomes were equal for the KOOS and Tegner activity scale scores at the 1-year follow-up, reduced improvements in KOOS were observed for QT-B compared to QT-S.

Conclusion

ACL with a QT autograft harvested either with a bone block or as a soft tissue graft exhibited comparable revision rates and sagittal knee stability. Furthermore, ACL reconstruction using a QT graft with a bone block achieved better rotational stability with less pivot shift than ACL reconstruction using complete soft tissue QT grafts.

Level of Evidence

Level III.

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有骨块和无骨块的股四头肌腱前交叉韧带重建术临床效果无差异：丹麦膝关节韧带注册的结果。

目的：由于采用微创采集技术且供体部位发病率低，股四头肌腱（QT）作为前交叉韧带重建（ACLR）移植物近来受到越来越多的关注。QT 移植物既可与髌骨块一起使用，也可作为完整的软组织移植物使用。然而，QT移植物的类型是否会影响临床效果尚不得而知。本研究利用丹麦膝关节韧带重建注册中心（DKRR）的数据，比较了使用带骨块的QT移植物（QT-B）或仅使用软组织移植物（QT-S）进行前交叉韧带重建的患者的翻修率、膝关节稳定性和主观临床效果：方法：纳入在 DKRR 中记录的使用 QT 自体移植物进行初级 ACL 重建的患者，并将其分为 QT-B（925 人）组和 QT-S （659 人）组。两组患者在1年随访时均使用客观仪器对膝关节稳定性、枢轴移位测试、膝关节损伤骨关节炎结果评分（KOOS）和Tegner活动评分进行了临床结果评估。同时还确定了总体翻修率：结果：两组移植物 2 年后的翻修率同样较低，均为 2.8%。同样，术后膝关节松弛度也相同，侧向松弛度分别为1.5（1.4）毫米和1.6（1.4）毫米。不过，与 QT-S 的 31% 相比，QT-B 的术后正枢轴移位减少了 22%。虽然在一年的随访中，KOOS和Tegner活动量表评分的主观结果相同，但与QT-S相比，QT-B的KOOS改善幅度较小：结论：使用 QT 自体移植物进行前交叉韧带重建，无论是骨块移植还是软组织移植，其翻修率和膝关节矢状稳定性都相当。此外，与使用完整软组织QT移植物进行前交叉韧带重建相比，使用带骨块的QT移植物进行前交叉韧带重建可获得更好的旋转稳定性，枢轴移位更少：证据等级：三级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).