BACKGROUND The patellar tendon is often considered the "gold standard" graft for reducing the risk of graft rupture after anterior cruciate ligament (ACL) reconstruction. However, its use may also be associated with an increased risk of injury to the contralateral ACL. PURPOSE To clarify the association between graft choice and the risk of revision and contralateral ACL reconstruction. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Prospective data captured by the New Zealand ACL Registry between April 2014 and December 2018 were reviewed. All primary ACL reconstructions performed using either a hamstring tendon or patellar tendon autograft were included. Cox regression survival analysis adjusting for patient factors was performed to compare the risk of revision and contralateral ACL reconstruction between the hamstring tendon graft and the patellar tendon graft. RESULTS A total of 7155 primary ACL reconstructions were reviewed, of which 5563 (77.7%) were performed using a hamstring tendon graft and 1592 (22.3%) were performed using a patellar tendon graft. Patients with a hamstring tendon graft had a revision rate of 2.7% compared with 1.3% in patients with a patellar tendon graft (adjusted hazard ratio [HR], 2.51; 95% CI, 1.55-4.06; P < .001). The patellar tendon graft was associated with an increased risk of contralateral ACL reconstruction compared with the hamstring tendon graft (adjusted HR, 1.91; 95% CI, 1.15-3.16; P = .012). The number needed to treat (NNT) with a patellar tendon graft to prevent 1 revision was 73.6. However, the NNT with a hamstring tendon graft to prevent 1 contralateral reconstruction was 116.3. CONCLUSION Use of a patellar tendon graft reduced the risk of graft rupture but was associated with an increased risk of injury to the contralateral ACL. Adequate rehabilitation and informed decision making on return to activity and injury prevention measures may be important in preventing subsequent injury to the healthy knee.

中文翻译：

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移植物选择对翻修和对侧前交叉韧带重建的影响：新西兰ACL注册中心的结果。

背景技术The骨腱通常被认为是“金标准”移植物，用于减少前交叉韧带（ACL）重建后的移植物破裂风险。但是，使用它也可能增加对侧ACL受伤的风险。目的阐明移植物选择与翻修和对侧ACL重建风险之间的关联。研究设计队列研究；证据级别：2。方法审查了新西兰ACL注册中心在2014年4月至2018年12月之间收集的前瞻性数据。包括使用a绳肌腱或pa腱自体移植术进行的所有主要ACL重建。进行了针对患者因素进行调整的Cox回归生存分析，以比较绳肌腱移植物和the骨肌腱移植物翻修和对侧ACL重建的风险。结果共审查了7155例原发性ACL重建，其中使用5绳肌腱移植进行了5563例（77.7％），使用a骨肌腱移植进行了1592例（22.3％）。绳肌腱移植的翻修率为2.7％，with骨肌腱移植的翻修率为1.3％（危险比[HR]为2.51； 95％CI为1.55-4.06； P <.001）。与the绳肌腱移植相比，tell肌腱移植与对侧ACL重建风险增加相关（校正后HR，1.91； 95％CI，1.15-3.16； P = 0.012）。需要进行tell骨腱移植治疗（NNT）以防止1次翻修的人数为73.6。但是，用ham绳肌腱移植物预防1次对侧重建的NNT为116.3。结论使用pa腱移植物可降低移植物破裂的风险，但会增加对侧ACL受伤的风险。充分的康复和恢复活动的明智决策以及预防伤害的措施对于预防健康膝盖的后续伤害可能很重要。