采用胫骨前腱、骨-髌腱-骨、腘绳肌腱或跟腱同种异体移植重建前交叉韧带的患者具有相似的临床结果和失败率：一项系统综述

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2025-04-01 DOI:10.1016/j.asmr.2024.101035

Udit Dave B.S. , Juan Bernardo Villarreal-Espinosa M.D. , Harshal Shah B.S. , Eric J. Cotter M.D. , Fernando Gómez-Verdejo M.D. , Melissa Carpenter B.S. , Cameron Gerhold B.S. , Alexander Mamonov , Jorge Chahla M.D., Ph.D. , Nikhil N. Verma M.D.

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引用次数: 0

摘要

目的比较同种异体前交叉韧带重建术（ACLR）与胫骨前肌（TA）肌腱、骨-髌腱-骨（BPTB）、腿筋（HT）和跟腱异体移植的术后疗效和功能。方法2024年4月，根据系统评价和meta分析的首选报告项目指南，对PubMed、Embase和Cochrane图书馆数据库进行全面检索。如果研究评估使用同种异体移植的原发性ACLR，前瞻性随机对照试验或回顾性研究，比较不同同种异体移植类型的原发性ACLR患者的结果，并在2000年至2024年间发表，则纳入研究。数据收集包括患者人口统计学特征、移植物类型、活动水平、钻孔技术、伴随和增强手术、患者报告的结果测量、并发症和移植物再破裂率。避免合并资料，进行定性资料比较。最初的检索确定了957项研究，其中7项纳入了本系统综述。其中5项为随机对照试验，2项为回顾性研究。共纳入735例患者，其中HT患者167例，BPTB患者252例，TA患者162例，跟腱患者153例。研究对象的平均年龄为23.9岁至37.2岁。研究的平均随访时间为25.6至90.0个月。移植队列的人口学特征相似，每项研究的偏倚风险都很低。研究的失败率从2%到65%不等。相似的国际膝关节文献委员会、Lysholm和Tegner评分在移植物类型中也有报道。此外，在原发性ACLR合并HT、BPTB、TA和跟腱同种异体移植物后，通过关节计读数的并排差异测量的功能结果和相似的并发症发生率也相似。结论：对于年龄大于23岁的患者，原发性ACLR与同种异体移植是安全有效的，患者报告的预后、术后功能和移植失败率在不同的移植方案中几乎没有差异。证据水平：IV级，对I级至IV级研究的系统评价。

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Patients Have Similar Clinical Outcomes and Failure Rates After Anterior Cruciate Ligament Reconstruction With Tibialis Anterior Tendon, Bone–Patellar Tendon–Bone, Hamstring Tendon, or Achilles Tendon Allografts: A Systematic Review

Purpose

To compare postoperative outcomes and functionality in patients who undergo primary allograft anterior cruciate ligament reconstruction (ACLR) with tibialis anterior (TA) tendon, bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and Achilles tendon allografts.

Methods

In April 2024, a comprehensive search of the PubMed, Embase, and Cochrane Library databases was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies were included if they evaluated primary ACLR using allograft, were prospective randomized controlled trials or retrospective studies, compared outcomes in patients undergoing primary ACLR with different allograft types, and were published between 2000 and 2024. Data collection included patient demographic characteristics, graft type, activity level, drilling technique, concomitant and augmentation procedures, patient-reported outcome measures, complications, and graft rerupture rates. Pooling of data was avoided, and qualitative data comparison was conducted.

Results

The initial search identified 957 studies, 7 of which were included in this systematic review. Of these, 5 were randomized controlled trials and 2 were retrospective studies. A total of 735 patients were included, with 167 HT patients, 252 BPTB patients, 162 TA patients, and 153 Achilles patients. The mean ages within the cohorts ranged from 23.9 to 37.2 years. The mean follow-up times across studies ranged from 25.6 to 90.0 months. Demographic characteristics were similar among the graft cohorts, and each study had a low risk of bias. Failure rates ranged from 2% to 65% across studies. Similar International Knee Documentation Committee, Lysholm, and Tegner scores were reported among the graft types. Additionally, similar functional outcomes as measured by side-by-side differences in arthrometer readings and similar complication rates after primary ACLR with HT, BPTB, TA, and Achilles allografts were found.

Conclusions

Primary ACLR with allografts in patients older than 23 years is safe and effective with few differences in patient-reported outcomes, postoperative function, and graft failure rates among graft options.