Introduction

ACL ligamentoplasty with a quadruple semitindosus graft (ST4) and double adjustable endobutton (ST4E) allow the preservation of the gracilis, which should allow more rapid recovery of soldiers following ACL reconstruction. However, the literature does not report any superiority of this technique over others in terms of return to duty and sport.

Hypothesis

The ST4E system allows a return to military duty at least equivalent to the semitendinosus and gracilis graft (STG) with screw fixation.

Material and method

A total of 133 soldiers operated on for ACL were included, 64 by the STG technique and 69 by ST4E, with an average follow-up of 4 years. The return to duty was assessed, with recovery of skills between the first and second postoperative year, as well as the medico-administrative status at the last follow-up, muscle recovery through isokinetic tests, the sports level before/after surgery, and the failure rate.

Results

No difference was found in the return to the soldier's previous post between the STG (64%) and the ST4E (64%) (p = 0.97). No difference was found for the medico-administrative status at the last follow-up, but the short-term muscle recovery, the return to sport, and the failure rate were in favor of the ST4E group.

Discussion

The ST4E, adjustable double endobutton system, is comparable to the STG technique in terms of return to military duty. On the other hand, it offers faster muscle recovery with better sports results and fewer patients on prolonged sick leave (PSL). This study demonstrated that two-thirds of soldiers operated on for anterior cruciate ligamentoplasty regained their initial aptitude regardless of the technique used, which influences the army's operational capacity and on disability pension requests after service.

Level of evidence

III, single center retrospective comparative study.

中文翻译：

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ACL 重建后军人重返岗位：STG 与 ST4 双可调环装置

介绍

ACL 韧带成形术采用四重半尖肌移植物 (ST4) 和双可调内扣 (ST4E) 可以保留股薄肌，这应该可以让士兵在 ACL 重建后更快恢复。然而，文献并未报告这种技术在重返岗位和运动方面优于其他技术。

假设

ST4E 系统允许重返军事职责，至少相当于使用螺钉固定的半腱肌和股薄肌移植物 (STG)。

材料与方法

共有 133 名士兵接受了 ACL 手术，其中 64 名采用 STG 技术，69 名采用 ST4E，平均随访 4 年。对重返工作岗位进行了评估，包括术后第一年和第二年的技能恢复情况，以及最后一次随访时的医疗管理状态、通过等速运动测试的肌肉恢复情况、手术前后的运动水平，以及失败率。

结果

STG (64%) 和 ST4E (64%) 在返回士兵之前的职位方面没有差异 ( p  =  0.97)。在最后一次随访时，药物管理状态没有发现差异，但短期肌肉恢复、重返运动和失败率有利于 ST4E 组。

讨论

ST4E，可调节双内扣系统，在返回军事任务方面可与 STG 技术相媲美。另一方面，它提供了更快的肌肉恢复、更好的运动效果和更少的长期病假 (PSL) 患者。这项研究表明，无论使用何种技术，三分之二接受前交叉韧带成形术手术的士兵都恢复了最初的能力，这会影响军队的作战能力和服役后的伤残抚恤金申请。

证据等级

三、单中心回顾性比较研究。