Tanner Clinic, Layton, Utah, USA.
Arthroscopy. 2012 Apr;28(4):539-47. doi: 10.1016/j.arthro.2011.09.007. Epub 2012 Jan 20.
The purpose of this study was to determine the optimal decision between autograft and allograft for patients undergoing anterior cruciate ligament (ACL) reconstruction.
An expected-value decision analysis with sensitivity analysis was performed to systematically quantify the clinical decision. We evaluated 100 randomly selected individuals aged 16 to 70 years with regard to the following variables: age, sex, activity level (International Knee Documentation Committee form), and visual analog scale regarding potential outcome preferences. Patients with prior ACL injury were excluded. A decision tree was constructed (allograft v autograft potential outcomes), and a literature review determined probabilities of potential outcomes. Statistical fold-back analysis calculated optimal treatment. Sensitivity analysis determined the effect of changing the outcome probabilities on the decision.
Of the subjects, 88 met the study inclusion criteria. The mean age was 44 years (range, 16 to 66 years), 67% of subjects were female, and the mean activity level was moderate. The expected value for autograft reconstruction was 11.22 versus 8.42 for allograft. Increasing the probability of complications associated with autograft (sensitivity analysis) decreased the expected value of autograft reconstruction. Significant limitations include that (1) decision analysis does not investigate actual patients in whom discussion of graft options between doctor and patient highly influences the decision and (2) patient decision largely depends on the information provided.
Decision analysis shows that autograft is preferred over allograft for ACL surgical reconstruction.
Patients' aversion to allograft tissue in general, and specific aversion to risk of disease transmission, results in a decision for ACL autograft, independent of expected outcomes.
本研究旨在确定接受前交叉韧带（ACL）重建的患者选择自体移植物和同种异体移植物的最佳方案。
我们进行了一项期望价值决策分析，并进行了敏感性分析，以系统地量化临床决策。我们评估了 100 名随机选择的年龄在 16 至 70 岁的个体，评估变量包括：年龄、性别、活动水平（国际膝关节文献委员会评分）以及对潜在结果偏好的视觉模拟评分。排除既往 ACL 损伤的患者。构建决策树（同种异体移植物与自体移植物的潜在结果），并通过文献复习确定潜在结果的概率。统计回溯分析计算最佳治疗方案。敏感性分析确定改变结果概率对决策的影响。
在符合研究纳入标准的 88 名受试者中，平均年龄为 44 岁（16 至 66 岁），67%的受试者为女性，平均活动水平为中度。自体移植物重建的期望值为 11.22，同种异体移植物重建的期望值为 8.42。增加与自体移植物相关的并发症概率（敏感性分析）会降低自体移植物重建的期望值。存在显著局限性，包括：（1）决策分析并未调查医生和患者之间讨论移植物选择的实际患者，而这种讨论对决策有很大影响；（2）患者决策在很大程度上取决于所提供的信息。
决策分析表明，自体移植物是 ACL 外科重建的首选。
患者普遍对同种异体移植物组织的厌恶，特别是对疾病传播风险的特定厌恶，导致 ACL 自体移植物的决策，而与预期结果无关。
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