LARS韧带与自体腘绳肌腱重建前交叉韧带的中期疗效比较

Medium-term Outcomes of Anterior Cruciate Ligament Reconstruction with LARS Artificial Ligament Versus Hamstring Tendon Autograft

目的比较韧带先进加强系统(ligament advanced reinforcement system,LARS)人工韧带与自体腘绳肌腱作为移植物重建前交叉韧带的中期临床疗效。方法回顾性分析2014年1月至2017年1月行关节镜下LARS人工韧带或自体腘绳肌腱重建前交叉韧带患者的临床及随访资料,比较两组的临床疗效。LARS人工韧带组25例(人工韧带组),自体腘绳肌腱组35例(自体肌腱组)。术前与术后随访采用Lysholm、Tegner、国际膝关节评分委员会(international knee documentation committee,IKDC)评分评价临床疗效,采用前抽屉试验(ADT试验)、Lachman试验评价术后膝关节稳定性。结果术后随访24~54个月,平均36个月。两组组内末次随访与术前比较,Lysholm、Tegner、IKDC评分升高,差异均有统计学意义( P <0.05);术前两组间Lysholm、Tegner、IKDC评分比较差异无统计学意义( P >0.05),术后末次随访人工韧带组与自体肌腱组在Lysholm评分、Tegner评分、IKDC评分、ADT试验及Lachman试验比较,差异均无统计学意义( P >0.05)。人工韧带组术后重返运动时间(19.52±2.33)周,明显早于自体肌腱组(29.54±2.33)周,差异有统计学意义( P <0.05)。结论关节镜下LARS韧带与自体腘绳肌腱重建前交叉韧带中期疗效相当,均可恢复膝关节功能与稳定性,但使用LARS韧带重建的患者能够早期重返运动。

Objective To assess the clinical outcome of anterior cruciate ligament reconstruction with LARS artificial ligament versus hamstring tendon autografts. MethodsWe designed retrospective study patients that anterior cruciate ligament reconstruction with LARS artificial ligament or hamstring tendon autografts to compare with the clinical outcome in the department between January 2014 and January 2017.Two groups of patients underwent surgeries with LARS artificial ligament (25 cases,Artificial ligament group) or hamstring tendon autograft (35 cases,Tendon autograft group).The Lysholm,Tegner score and International Knee Documentation Committee (IKDC) score of patients before and last follow-up after operation were assessed.The objective knee stability was assessed by side to side difference of anterior drawer test and Lachman test. ResultsAll the patients were followed up 24 to 54 months,with a mean of 36 months.The Lysholm,Tegner,IKDC score are improved in the two groups before surgery and in last follow-up.There were statistically significant difference( P <0.05).Before surgery there was no significant difference in the Lysholm,Tegner,IKDC score ( P >0.05).Compared the Artificial ligament group with the Tendon autograft group at the latest follow up,the Lysholm score,Tegner sore,IKDC score,anterior drawer test and Lachman test were no statistical differences between the two groups ( P >0.05).The time to return sport was (19.52±2.33) weeks in the Artificial ligament group,whereas (29.54±2.33) weeks in the Tendon autograft group,where existed a statistical difference between them ( P <0.05). ConclusionBoth the LARS artificial ligament and the hamstring tendon autograft are effective for ACL reconstruction to regain knee function and stability with similar medium-term clinical consequences.However,the LARS artificial ligament takes an advantage of earlier return to sport over the hamstring tendon autograft.