Hamstring autograft, bone-patellar-tendon-bone autograft and synthetic graft in primary anterior cruciate ligament reconstruction: A meta-analysis of comparative studies

IF 2 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-07-18 DOI:10.1002/jeo2.70326

Michele Mercurio, Erminia Cofano, Orlando Cosentino, Katia Corona, Fabrizio Mocini, Umberto Rossi, Olimpio Galasso, Giorgio Gasparini, Simone Cerciello

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引用次数: 0

Abstract

Purpose

Anterior cruciate ligament reconstruction (ACLR) yields favourable results, but failure and reinjury rates are still a concern. Graft choice is a modifiable risk factor for surgeons to avoid failure. The topic of optimal graft selection remains a subject of ongoing debate. Graft choices include autografts, allografts and synthetic grafts. The purpose of this meta-analysis was to compare functional outcomes and complications between autografts, hamstring (HT) tendon and bone-patellar-tendon-bone, and synthetic graft in primary ACLR.

Methods

The PubMed, MEDLINE, Scopus and Cochrane Central databases were used for the research, and nine studies were included. The first author, journal name, year of publication, patient demographics, type of surgery, type of graft used for ACLR, time from injury to surgery, and follow-up period were recorded. The data extracted for quantitative analysis included Lysholm activity scale score, Tegner activity scale score, International Knee Documentation Committee (IKDC) score, laxity measured with the KT-1000 knee arthrometer (KT-1000), number of complications, re-rupture, and re-intervention rates. Random and fixed effect models were used for the meta-analysis of pooled mean differences (MDs) and odds ratios (ORs).

Results

A total of 734 patients were identified, 377 of whom underwent ACLR with autograft and 326 with synthetic graft. The mean age was 28.7 ± 20.3 and 31.6 ± 9.3 years for the ACLR with autograft and ACLR with synthetic graft groups. The mean follow-up durations were 82.3 ± 38 and 81.4 ± 39.2 months. Comparable postoperative Lysholm knee score (p = 0.06), Tegner activity scale score (p = 0.64) and IKDC score (p = 0.15) were found between groups. Significantly greater knee laxity was found in the autograft group (2.6 ± 1.4 and 1.5 ± 1.4 mm; MD = 1.22, 95% confidence interval [CI]: 0.96, 1.48; p < 0.001). Comparable overall complications (p = 0.70), re-rupture (p = 0.81) and re-intervention (p = 0.85) rates were found between groups.

Conclusions

Compared to ACLR with HT autograft, the ACLR with synthetic graft showed statistically but not clinically important decreased knee laxity. Comparable functional outcomes, complication and re-rupture rates were found between the two groups.

Level of Evidence

Level I, meta-analysis.

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腘绳自体移植物、骨-髌骨-肌腱-骨自体移植物和合成移植物在原发性前交叉韧带重建中的应用：比较研究的荟萃分析

目的前交叉韧带重建术（ACLR）取得了良好的效果，但其失败率和再损伤率仍然令人担忧。移植物的选择是外科医生避免失败的一个可改变的危险因素。最佳移植物选择的话题仍然是一个持续争论的主题。移植物的选择包括自体移植物、同种异体移植物和合成移植物。本荟萃分析的目的是比较自体移植物、腿筋（HT）肌腱、骨-髌骨-肌腱-骨和合成移植物在原发性ACLR中的功能结局和并发症。方法采用PubMed、MEDLINE、Scopus和Cochrane Central数据库，共纳入9篇研究。记录第一作者、期刊名称、发表年份、患者人口统计、手术类型、ACLR使用的移植物类型、从损伤到手术的时间以及随访时间。提取用于定量分析的数据包括Lysholm活动量表评分、Tegner活动量表评分、国际膝关节文献委员会（IKDC）评分、用KT-1000膝关节计（KT-1000）测量的松弛度、并发症数量、再破裂和再干预率。随机效应和固定效应模型用于汇总平均差异（MDs）和优势比（ORs）的荟萃分析。结果共发现734例患者，其中377例行自体移植物ACLR， 326例行人工移植物ACLR。自体移植ACLR组和人工移植ACLR组的平均年龄分别为28.7±20.3岁和31.6±9.3岁。平均随访时间分别为82.3±38个月和81.4±39.2个月。术后Lysholm膝关节评分（p = 0.06）、Tegner活动量表评分（p = 0.64）和IKDC评分（p = 0.15）组间比较。自体移植物组膝关节松弛度明显增大（2.6±1.4 mm和1.5±1.4 mm）；MD = 1.22, 95%可信区间[CI]: 0.96, 1.48；p < 0.001)。两组总并发症发生率（p = 0.70）、再破裂率（p = 0.81）和再干预率（p = 0.85）相当。结论与自体HT移植ACLR相比，人工合成ACLR的膝关节松弛程度有统计学意义，但临床意义不显著。两组的功能结局、并发症和再破裂率比较。证据水平一级，荟萃分析。

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