Joyce Christopher D, Randall Kyle L, Mariscalco Michael W, Magnussen Robert A, Flanigan David C
The Ohio State University Sports Medicine Center and Cartilage Restoration Program, Columbus, Ohio, U.S.A.
The Ohio State University Sports Medicine Center and Cartilage Restoration Program, Columbus, Ohio, U.S.A..
Arthroscopy. 2016 Feb;32(2):394-402. doi: 10.1016/j.arthro.2015.08.003. Epub 2015 Sep 28.
To describe the outcomes of bone-patellar tendon-bone (BPTB) and soft-tissue allografts in anterior cruciate ligament (ACL) reconstruction with respect to graft failure risk, physical examination findings, instrumented laxity, and patient-reported outcomes.
A search of the PubMed, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) Complete, Cochrane Collaboration, and SPORTDiscus databases was performed. English-language studies with outcome data on primary ACL reconstruction with nonirradiated BPTB and soft-tissue allografts were identified. Outcome data included failure risk, physical examination findings, instrumented laxity measurements, and patient-reported outcome scores.
Seventeen studies met the inclusion criteria. Of these studies, 11 reported on BPTB allografts exclusively, 5 reported on soft-tissue allografts exclusively, and 1 compared both types. The comparative study showed no difference in failure risk, Lachman grade, pivot-shift grade, instrumented laxity, or overall International Knee Documentation Committee score between the 2 allograft types. Data from all studies yielded a failure risk of 10.3% (95% confidence interval [CI], 4.5% to 18.1%) in the soft-tissue group and 15.2% (95% CI, 11.3% to 19.6%) in the BPTB group. The risk of a Lachman grade greater than 5 mm was 6.4% (95% CI, 1.7% to 13.7%) in the soft-tissue group and 8.6% (95% CI, 6.3% to 11.2%) in the BPTB group. The risk of a grade 2 or 3 pivot shift was 1.4% (95% CI, 0.3% to 3.3%) in the soft-tissue group and 4.1% (95% CI, 1.9% to 7.2%) in the BPTB group.
One comparative study showed no difference in results after ACL reconstruction with nonirradiated BPTB and soft-tissue allografts. Inclusion of case series in the analysis showed qualitatively similar outcomes with the 2 graft types.
描述在前交叉韧带（ACL）重建中，骨-髌腱-骨（BPTB）和软组织同种异体移植物在移植物失败风险、体格检查结果、仪器测量的松弛度以及患者报告的结果方面的情况。
对PubMed、Scopus、CINAHL（护理及相关健康文献累积索引）完整版、Cochrane协作网和SPORTDiscus数据库进行检索。纳入关于使用未辐照的BPTB和软组织同种异体移植物进行初次ACL重建的结果数据的英文研究。结果数据包括失败风险、体格检查结果、仪器测量的松弛度以及患者报告的结果评分。
17项研究符合纳入标准。在这些研究中，11项仅报告了BPTB同种异体移植物，5项仅报告了软组织同种异体移植物，1项对两种类型进行了比较。该比较研究表明，两种同种异体移植物类型在失败风险、Lachman分级、轴移分级、仪器测量的松弛度或国际膝关节文献委员会总体评分方面没有差异。所有研究的数据显示，软组织组的失败风险为10.3%（95%置信区间[CI]，4.5%至18.1%），BPTB组为15.2%（95%CI，11.3%至19.6%）。软组织组Lachman分级大于5mm的风险为6.4%（95%CI，1.7%至13.7%），BPTB组为8.6%（95%CI，6.3%至11.2%）。软组织组2级或3级轴移的风险为1.4%（95%CI，0.3%至3.3%），BPTB组为4.1%（95%CI，1.9%至7.2%）。
一项比较研究表明，使用未辐照的BPTB和软组织同种异体移植物进行ACL重建后的结果没有差异。分析中纳入病例系列显示，两种移植物类型的结果在质量上相似。
