选择各种移植物以恢复膝关节稳定性并在前交叉韧带(ACL)断裂后恢复损伤前活动水平。这篇综述旨在比较不同肌腱移植物用于初次ACL重建(ACLR)的短期膝关节疗效。
PubMed的数据库,Embase,检索CENTRAL用于鉴定已发表的RCT,比较不同肌腱移植物对ACLR的短期(≤2年)膝关节结局.主要结果包括国际膝关节文献委员会(IKDC)的主观和客观评分,膝盖松弛的左右差异,拉赫曼测试,枢轴移位测试,Lysholm得分,Tegner得分,所有记录的并发症和移植物再破裂。
共纳入32项试验,涉及2962例患者和17例移植物。与包括骨-髌腱-骨(BPTB)在内的自体移植物相比,股四头肌腱自体移植物(QTB)的IKDC主观评分更高,四股绳肌腱(4S-HT),和双束HT。与BPTB自体移植物相比,4S-HT自体移植物的前后和旋转膝关节稳定性较差。还发现,与包括BPTB在内的自体移植物相比,人工韧带的膝关节稳定性较低,髌腱,4S-HT,保留胫骨插入的4S-HT,6S-HT,和四股半腱肌腱。此外,BPTB同种异体移植物比6S-HT同种异体移植物显示出统计学上更高的膝关节松弛度,而真正的自体移植物和未辐照的同种异体移植物之间没有发现差异。
建议甚至在BPTB和4S-HT自体移植物上使用QTB。BPTB自体移植比4S-HT自体移植更有效地恢复膝关节稳定性。未经辐照的同种异体移植物可以安全地用作自体移植物的替代品。然而,由于膝关节松弛的风险显著增加,因此不建议将人工韧带用于原发性ACLR.
Various grafts were selected for restoring knee stability and regaining pre-injury activity levels after anterior cruciate ligament (ACL) rupture. This review aimed to compare the short-term knee outcomes of different tendon grafts for primary ACL reconstruction (ACLR).
Databases of PubMed, Embase, and CENTRAL were retrieved for identifying the published RCT comparing the short-term (≤ 2 years) knee outcomes of different tendon grafts for ACLR. The main outcomes include the International Knee Documentation Committee (IKDC) subjective and objective scores, side-to-side difference on knee laxity, Lachman test, pivot-shift test, Lysholm score, Tegner score, all recorded complications and graft re-ruptures.
A total of 32 trials involving 2962 patients and 17 grafts were included. Superior IKDC subjective score was found for quadriceps tendon autograft (QTB) when compared with autografts including bone-patellar tendon-bone (BPTB), four-strand hamstring tendon (4S-HT), and double-bundle HT. The 4S-HT autograft was associated with poorer anteroposterior and rotational knee stability than the BPTB autograft. Artificial ligament also was found to provide lower knee stability compared with the autografts including the BPTB, patellar tendon, 4S-HT, 4S-HT with preserved tibial insertion, 6S-HT, and four-strand semitendinosus tendon. Additionally, the BPTB allograft showed a statistically higher knee laxity than 6S-HT allograft, while no difference was found between the genuine autografts and non-irradiated allografts.
QTB was recommended to be used even over the BPTB and 4S-HT autografts. BPTB autograft was more effective on restoring the knee stability than 4S-HT autograft. Non-irradiated allografts could be safely used as alternatives to autografts. However, artificial ligaments were not recommended for primary ACLR for significantly increased risk of knee laxity.