Purpose

Recent registry data have demonstrated a higher revision rate of quadriceps tendon (QT) graft compared with hamstring tendon (HT) and patellar tendon (PT) grafts. Clinic routines could be an important factor for revision outcomes. The purpose of this study is to use the Danish Knee Ligament Reconstruction Registry (DKRR) to compare revision rates in patients who have undergone ACLR with QT, HT and PT grafts related to individual clinic surgical routine.

Methods

Data on primary ACLRs entered in the DKRR from 2012 through 2019 were analysed since QT graft usage started in 2012. Revision rates for QT, HT and PT grafts were compared according to clinic activity (0–100 and > 100 procedures). Revision rates for the three autograft cohorts are presented, as well as adjusted revision hazard rates. Instrumented knee stability and pivot-shift tests were performed at a one-year follow-up.

Result

QT revision rate (6.4%) for low-activity clinics was higher than for high-activity clinics (2.9%) (p = 0.003). The adjusted revision hazard ratio for low-activity clinics was 2.3 (p = 0.01). QT autograft was associated with statistically significant, increased side-to-side laxity at follow-up (1.4 mm) compared with HT and PT autografts (1.0 mm) (p < 0.01), as well as an increased positive pivot-shift rate.

Conclusion

QT autografts for ACLR were associated with higher revision rates in clinics with lower than 100 procedures performed from 2012 to 2019. QT graft usage is not associated with a high revision rate when routinely performed. Learning curve is an important factor when introducing QT ACLR.

Level of evidence

Level III

中文翻译：

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低位外科手术可增加股四头肌腱自体移植后前十字韧带重建的翻修率：丹麦膝韧带重建注册中心的结果。

目的

最新的注册表数据显示，与绳肌腱（HT）和pa骨腱（PT）移植相比，股四头肌腱（QT）移植的翻修率更高。临床常规可能是修订结果的重要因素。这项研究的目的是使用丹麦膝关节韧带重建注册系统（DKRR）来比较接受ACLR与个别临床手术常规相关的QT，HT和PT移植的ACLR患者的翻修率。

方法

自2012年开始使用QT移植物以来，分析了2012年至2019年进入DKRR的主要ACLR的数据。根据临床活动（0–100和> 100程序）比较了QT，HT和PT移植物的修订率。列出了三个自体移植队列的修订率，以及调整后的修订风险率。在一年的随访中进行了仪器化的膝关节稳定性和枢轴移位测试。

结果

低活动诊所的QT修订率（6.4％）高于高活动诊所的（2.9％）（p  = 0.003）。低活跃度诊所的修订后修订风险比为2.3（p  = 0.01）。与HT和PT自体移植（1.0 mm）相比，QT自体移植与随访时（1.4 mm）有统计学意义的侧向松驰度增加（p  <0.01），以及正枢轴移位率增加。

结论

在2012年至2019年执行的手术少于100例的诊所中，ACLR的QT自体移植与更高的修订率相关。常规执行QT移植物使用与高修订率无关。学习曲线是引入QT ACLR时的重要因素。

证据水平

第三级