자가 골-슬개건-골과 동종 아킬레스 건을 이용한 전방십자인대 재건술의 임상결과 비교

Abstract

Purpose: To compare clinical outcomes after arthroscopic ACL reconstruction using bone-patellar tendon-bone autograft and using fresh-frozen Achilles tendon allograft. Materials and Methods: We enrolled 61 patients who underwent anterior cruciate ligament reconstruction by means of bone-patellar tendon-bone autograft or Achilles tendon allograft between March, 2002 and December, 2006. The bone-patellar tendon-bone group included 29 patients (mean age 30.4 years), and the Achilles tendon allograft group included 32 patients (mean age 32.5 years). The mean follow-up was 18.2 months and 25.7 months in each group, respectively. Preoperative and last follow-up clinical results were evaluated through physical examination, KT-2000 arthrometer, stress roentgenogram, IKDC knee rating system, and Lysholm knee score. Results: The mean side-to-side difference in anterior translation, as measured by KT-2000 arthrometer, was significantly improved from 6.4 ㎜±3.0 to 3.2 ㎜±1.9 in the bone-patellar tendon-bone group, and from 7.6 ㎜±3.1 to 2.9 ㎜±2.0 in the Achilles tendon allograft group (p ＜ 0.001). The Achilles tendon allograft group improved more significantly than did the bone-patellar tendon-bone group (p＝0.045). The mean side-to-side difference on stress roentgenogram was significantly improved from 5.3 ㎜±2.5 to 2.0 ㎜±2.1 in the bone-patellar tendon-bone group, and from 6.0 ㎜±3.4 to 2.2 ㎜±2.1 in the Achilles tendon allograft group (p ＜ 0.001). There was no significant difference between the two groups. According to the IKDC knee rating system at last follow-up, 26 (89.7%) patients in the bone-patellar tendon-bone group and 28 (87.5%) patients in the Achilles allograft group were normal or nearly normal. The mean Lysholm knee score significantly improved from 69.9 to 90.2 in the bone-patellar tendon-bone group, and from 64.4 to 91.4 in the Achilles tendon allograft group (p ＜ 0.001). Conclusion: Both bone-patellar tendon-bone and Achilles tendon allograft groups showed satisfactory clinical results, with no significant difference in outcomes between the groups. We suggest that both bone-patellar tendon-bone autograft and Achilles tendon allograft be considered as graft substitutes for anterior cruciate ligament reconstruction.