Ciccotti Michael C, Secrist Eric, Tjoumakaris Fotios, Ciccotti Michael G, Freedman Kevin B
Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.
Arthroscopy. 2017 May;33(5):1062-1071.e5. doi: 10.1016/j.arthro.2017.01.033. Epub 2017 Mar 27.
To collect the highest level of evidence comparing anatomic anterior cruciate ligament (ACL) reconstruction via independent tunnel drilling using bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts in terms of clinical outcome and failure rate.
We performed a systematic review of clinical trials that randomized patients to ACL reconstruction with either BTB or HT autografts with a minimum 2-year follow-up. Only trials using independent tunnel drilling, including outside-in and anteromedial portal techniques, for both autografts were eligible for inclusion, whereas all transtibial studies were excluded. Study design, demographics, surgical technique, rehabilitation protocol, and clinical outcomes were compiled. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Quality assessment was performed using the Coleman Methodological Scale (CMS).
Six published studies reporting on 5 randomized controlled trials (RCTs) met the inclusion criteria. No study reported a difference in rerupture rate between BTB and HT. BTB-reconstructed knees experienced a greater incidence of anterior knee pain or crepitus in 2/7 trials and radiographic evidence of degenerative change in 3/7 trials. HT-reconstructed knees had increased instrumented laxity in 2/7 trials and less knee flexion strength postoperatively.
This study collects all available Level I and II evidence for anatomic ACL reconstruction using BTB and HT grafts. According to the data presented in these studies, clinical outcome scores and failure rates showed no differences for anatomic reconstruction using either autograft. However, in some studies, BTB-reconstructed knees experienced a greater incidence of anterior knee pain and radiographic evidence of degenerative change, and in others, HT-reconstructed knees had increased laxity and less knee flexion strength. In our opinion, both BTB and HT autografts remain valid options for ACL reconstruction when using anatomic drilling techniques, providing a stable knee with reliable return to activity.
Level II, systematic review of Level I and II studies.
收集最高水平的证据，比较采用骨-髌腱-骨（BTB）和腘绳肌腱（HT）自体移植物通过独立隧道钻孔进行解剖学前交叉韧带（ACL）重建的临床疗效和失败率。
我们对临床试验进行了系统评价，这些试验将患者随机分为接受BTB或HT自体移植物的ACL重建，且随访时间至少为2年。仅纳入对两种自体移植物均采用独立隧道钻孔（包括由外向内和前内侧入路技术）的试验，而所有经胫骨的研究均被排除。收集了研究设计、人口统计学、手术技术、康复方案和临床疗效等信息。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。使用科尔曼方法学量表（CMS）进行质量评估。
六项发表的研究报告了5项随机对照试验（RCT），符合纳入标准。没有研究报告BTB和HT之间再破裂率的差异。在2/7的试验中，BTB重建的膝关节出现前膝疼痛或弹响的发生率更高，在3/7的试验中有退变改变的影像学证据。在2/7的试验中，HT重建的膝关节仪器测量的松弛度增加，术后膝关节屈曲力量较小。
本研究收集了所有关于使用BTB和HT移植物进行解剖学ACL重建的可用I级和II级证据。根据这些研究中的数据，两种自体移植物进行解剖学重建的临床疗效评分和失败率没有差异。然而，在一些研究中，BTB重建的膝关节出现前膝疼痛的发生率更高且有退变改变的影像学证据，而在另一些研究中，HT重建的膝关节松弛度增加且膝关节屈曲力量较小。我们认为，当采用解剖学钻孔技术时，BTB和HT自体移植物仍然是ACL重建的有效选择，可提供稳定的膝关节并可靠地恢复活动。
II级，对I级和II级研究的系统评价。
