Abstract：
BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is most commonly performed with hamstring tendon (HT) or bone-patellar tendon-bone (BTB) autografts, although the quadriceps tendon (QT) autograft has recently increased in popularity. This systematic review and meta-analysis review compares QT and HT autografts for primary ACLR with a sole focus on randomised controlled trials (RCTs).
METHODS: A prospective protocol was registered on PROSPERO (CRD42023427339). The search included MEDLINE, Embase and Web of Science until February 2024. Only comparative RCTs were included. The primary outcome was the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score. Secondary outcomes included: other validated patient-reported outcome measures (PROMs), objective strength scores, complications, and return to sport and work.
RESULTS: From 2,609 articles identified, seven were included (n = 474 patients). This meta-analysis did not identify a significant difference in post-operative IKDC scores (5 articles; p = 0.73), Lysholm scores (3 studies; p = 0.80) or Tegner activity scales (2 studies; p = 0.98). There were no differences in graft failure rates (4 studies; p = 0.92) or in overall adverse events (4 studies; p = 0.83) at 24 months post-ACLR as per meta-analysis. Donor site morbidity scores were significantly lower in the QT group (MD -4.67, 95% CI -9.29 to -0.05; 2 studies, 211 patients; p = 0.05, I2 = 34%).
CONCLUSIONS: There were no differences between QT and HT in PROMs, graft failure rates or overall complications based on low- to moderate-quality evidence. There may possibly be lower donor site morbidity with the QT autograft, however, the evidence is not sufficient to draw definitive conclusions.
METHODS: A prospective protocol was registered on PROSPERO (CRD42023427339). The search included MEDLINE, Embase and Web of Science until February 2024. Only comparative RCTs were included. The primary outcome was the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form score. Secondary outcomes included: other validated patient-reported outcome measures (PROMs), objective strength scores, complications, and return to sport and work.
RESULTS: From 2,609 articles identified, seven were included (n = 474 patients). This meta-analysis did not identify a significant difference in post-operative IKDC scores (5 articles; p = 0.73), Lysholm scores (3 studies; p = 0.80) or Tegner activity scales (2 studies; p = 0.98). There were no differences in graft failure rates (4 studies; p = 0.92) or in overall adverse events (4 studies; p = 0.83) at 24 months post-ACLR as per meta-analysis. Donor site morbidity scores were significantly lower in the QT group (MD -4.67, 95% CI -9.29 to -0.05; 2 studies, 211 patients; p = 0.05, I2 = 34%).
CONCLUSIONS: There were no differences between QT and HT in PROMs, graft failure rates or overall complications based on low- to moderate-quality evidence. There may possibly be lower donor site morbidity with the QT autograft, however, the evidence is not sufficient to draw definitive conclusions.
摘要：
背景：前交叉韧带重建术（ACLR）最常见于绳肌腱（HT）或骨-髌腱-骨（BTB）自体移植物，尽管股四头肌腱（QT）自体移植最近越来越受欢迎。本系统评价和荟萃分析评价比较了原发性ACLR的QT和HT自体移植物，仅关注随机对照试验（RCTs）。
方法：在PROSPERO（CRD42023427339）上注册了前瞻性方案。搜索包括MEDLINE,Embase和WebofScience至2024年2月。仅包括比较性RCT。主要结果是国际膝关节文献委员会（IKDC）主观膝关节评估表评分。次要结局包括：其他经过验证的患者报告结局指标（PROM），客观实力得分，并发症,回到运动和工作。
结果：从确定的2,609篇文章中，纳入7例(n=474例).此荟萃分析未发现术后IKDC评分的显着差异（5篇文章；p=0.73），Lysholm评分（3项研究；p=0.80）或Tegner活动量表（2项研究；p=0.98）。根据荟萃分析，在ACLR后24个月，移植物失败率（4项研究；p=0.92）或总体不良事件（4项研究；p=0.83）没有差异。QT组的供体部位发病率评分明显较低(MD-4.67,95%CI-9.29至-0.05;2项研究,211例患者；p=0.05，I2=34%）。
结论：PROM的QT和HT之间没有差异，基于低到中等质量证据的移植物失败率或总体并发症。QT自体移植物的供体部位发病率可能较低，然而,证据不足以得出明确的结论。
方法：在PROSPERO（CRD42023427339）上注册了前瞻性方案。搜索包括MEDLINE,Embase和WebofScience至2024年2月。仅包括比较性RCT。主要结果是国际膝关节文献委员会（IKDC）主观膝关节评估表评分。次要结局包括：其他经过验证的患者报告结局指标（PROM），客观实力得分，并发症,回到运动和工作。
结果：从确定的2,609篇文章中，纳入7例(n=474例).此荟萃分析未发现术后IKDC评分的显着差异（5篇文章；p=0.73），Lysholm评分（3项研究；p=0.80）或Tegner活动量表（2项研究；p=0.98）。根据荟萃分析，在ACLR后24个月，移植物失败率（4项研究；p=0.92）或总体不良事件（4项研究；p=0.83）没有差异。QT组的供体部位发病率评分明显较低(MD-4.67,95%CI-9.29至-0.05;2项研究,211例患者；p=0.05，I2=34%）。
结论：PROM的QT和HT之间没有差异，基于低到中等质量证据的移植物失败率或总体并发症。QT自体移植物的供体部位发病率可能较低，然而,证据不足以得出明确的结论。
