SPORTS MEDICINE
Quality of Life and Clinical Outcome Comparison of Semitendinosus and Gracilis Tendon Versus Patellar Tendon Autografts for Anterior Cruciate Ligament Reconstruction: An 11-Year Follow-up of a Randomized Controlled Trial
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OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):298 Am J Sports Med; 2011; 39(10): 2161-2169Exclusive Author Interview
Dr. Sajovic comparing ACL hamstring and patellar tendon autografts
64 patients scheduled to undergo reconstruction for anterior cruciate ligament (ACL) ruptures were randomized to receive either hamstring tendon autograft or patellar tendon autograft. The results from 11 year follow-up indicated that there were no significant differences between the two groups in regards to functional or pain outcomes.It was also found that there were no significant differences in rate of graft failures between the two groups. However, the patellar tendon autograft group had a higher prevalence of osteoarthritis at 11 years.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実=0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomização
3/4
Medidas de resultado
4/4
Inclusão/Exclusão
4/4
Descrição do tratamento
4/4
Estatística
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか?
ACL injuries are common sports injuries, often in the younger population. The return to sports, long life, and prevention of secondary osteoarthritis are of primary importance. The choice of graft is an important decision for both the patient and the surgeon. Controversies still exist about graft selection for primary anterior cruciate ligament reconstruction. This study evaluates the long 14-year outcomes with two most common autografts (hamstring tendon autograft or patellar tendon autograft) used in ACL repair.
主な研究課題は何ですか?
Does patellar tendon autograft lead to similar functional and pain outcomes in comparison to hamstring tendon autograft in patients with ACL ruptures at 11 year follow-up?
重要な知見は?
- preoperative versus postoperative Lysholm knee scores showed a significant improvement in both groups (p<0.001)
- a greater number of patients reported anterior knee pain during strenuous activities or in kneeling-squatting position in the patellar tendon autograft group in comparison to the hamstring tendon autograft group (p=0.255)
- positive pivot-shift test (1 ) was significantly more frequent in the PT group (p=0.036)
- no significant differences in Short Form-36 or KT-1000 arthrometer laxity testing scores were observed between the two groups (p>0.05)
最も覚えておくべきことは?
Both interventions provided similar improvements in outcomes; however, it was found that the rate of osteoarthritis was significantly higher in the patellar tendon autograft group.
それが私の患者ケアにどのように影響するか?
Similar long-term results could be obtained by using either hamstring tendon or patellar tendon autografts in patients undergoing ACL reconstruction.
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