■刚度的变化,固定方法,不同移植类型和前交叉韧带缝合修复(ACLSR)的前交叉韧带重建(ACLR)后的供体部位发病率可导致动态膝关节松弛的差异,并因此导致创伤后骨关节炎(PTOA)发展的差异。
■比较用于原发性ACLR的不同移植物类型之间以及原发性ACLR和ACLSR之间的PTOA发生率。据推测,PTOA的发生率在具有不同自体移植物和同种异体移植物的ACLR之间以及ACLR和ACLSR之间会有所不同。
■系统评价;证据水平,1.
■进行了文献搜索,以确定所有随机对照试验(RCT),比较了不同类型的移植物-绳肌腱(HT)自体移植物之间ACLR后PTOA的影像学证据,骨-髌腱-骨(BPTB)自体移植,股四头肌腱自体移植,和同种异体移植-以及ACLR和ACLSR之间。最少随访2年。使用改良的Coleman方法评分评估研究质量。进行荟萃分析以确定不同移植物类型之间以及ACLR和ACLSR之间的PTOA发生率是否存在差异。
■11项随机对照试验纳入荟萃分析-HT:440例患者(平均随访,9.7年);BPTB:307例患者(平均随访,11.8年);同种异体移植:246例患者(平均随访,5年);ACLSR,22例(5年)。未纳入报告股四头肌腱ACLR后发生率的研究。研究质量从70到88。荟萃分析表明,用于ACLR的移植物类型之间以及ACLR和ACLSR之间的PTOA发生率没有显着差异(风险比:HTvsBPTB,1.05;HT与同种异体移植物,0.81;BPTB与同种异体移植物,0.82;HT与ACLSR,不可估计的[全部P>.05])。在每种移植物类型的所有研究中,患有PTOA的患者的合并数量表明,接受BPTB自体移植物的ACLR患者的PTOA百分比最高(HT,23.4%;BPTB,29.6%;同种异体移植,8.1%;ACLSR,0%)。然而,排除随访<5年的研究,对于接受HT自体移植和BPTB自体移植的患者,结果相似.
■这项荟萃分析报告,用于ACLR的移植物类型之间以及ACLR和ACLSR之间的PTOA发生率没有差异。需要更多的研究才能得出可靠的结论,即哪种技术与ACL手术后的PTOA发生率最低有关。
UNASSIGNED: Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development.
UNASSIGNED: To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR.
UNASSIGNED: Systematic
review; Level of evidence, 1.
UNASSIGNED: A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types-hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and
allograft-and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR.
UNASSIGNED: Eleven randomized controlled trials were included in the meta-analysis-HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs
allograft, 0.81; BPTB vs
allograft, 0.82; HT vs ACLSR, not estimable [P > .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%;
allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up <5 years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft.
UNASSIGNED: This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowest incidence of PTOA after ACL surgery.