Poehling-Monaghan Kirsten L, Salem Hytham, Ross Kirsten E, Secrist Eric, Ciccotti Michael C, Tjoumakaris Fotios, Ciccotti Michael G, Freedman Kevin B
Rothman Institute, Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Orthop J Sports Med. 2017 Jun 14;5(6):2325967117709735. doi: 10.1177/2325967117709735. eCollection 2017 Jun.
Much controversy still exists surrounding graft choice in anterior cruciate ligament (ACL) reconstruction. Over the past decade, an increase in comparative studies with longer follow-up has enhanced our understanding of current graft options and outcomes.
To describe the long-term comparative outcomes of ACL reconstruction with autograft bone-patellar tendon-bone (BPTB) versus autograft hamstring (HS) ACL reconstruction with regard to clinical and radiographic outcomes.
Systematic review; Level of evidence, 2.
A search of the PubMed, MEDLINE, Cochrane, and Scopus databases was performed to identify studies in the English language with outcome data comparing ACL reconstruction utilizing autograft BPTB and autograft HS; only studies with a minimum 5-year follow-up were included. Outcome data included failure and complications, manual and instrumented laxity, patient-reported outcomes, and radiographic risk of osteoarthritis.
Twelve studies with a total of 953 patients met the inclusion criteria. Of these studies, 8 were level 1 evidence and 2 were level 2. Mean follow-up was 8.96 years (range, 5-15.3 years). No differences in graft failure or manual or instrumented laxity were seen in any studies. Lower clinical outcomes scores and greater motion loss were seen in BPTB patients in 1 and 2 studies, respectively. Two of 4 studies reporting on anterior knee pain, and 3 of 7 that recorded kneeling pain found it more frequently among BPTB patients. One study found significantly increased reoperation rates in HS patients, while another found a similar result in BPTB, and 1 study reported a significant increase in contralateral ACL tears in BPTB patients. Three of 5 studies reporting on radiographic evidence of osteoarthritis noted significantly increased rates in BPTB patients.
This systematic review comparing long-term outcomes after ACL reconstruction with either autograft BPTB or autograft HS suggests no significant differences in manual/instrumented laxity and graft failures between graft types. An increase in long-term anterior knee pain, kneeling pain, and higher rates of osteoarthritis were noted with BPTB graft use.
在前交叉韧带（ACL）重建中，移植物的选择仍存在诸多争议。在过去十年中，随访时间更长的比较研究有所增加，这增进了我们对当前移植物选择及其结果的理解。
描述自体骨 - 髌腱 - 骨（BPTB）与自体腘绳肌（HS）ACL重建在临床和影像学结果方面的长期比较结果。
系统评价；证据等级，2级。
检索了PubMed、MEDLINE、Cochrane和Scopus数据库，以识别用英文发表的、有比较使用自体BPTB和自体HS进行ACL重建结果数据的研究；仅纳入了随访至少5年的研究。结果数据包括失败和并发症、手法和仪器测量的松弛度、患者报告的结果以及骨关节炎的影像学风险。
12项研究共953例患者符合纳入标准。其中，8项为1级证据，2项为2级证据。平均随访时间为8.96年（范围5 - 15.3年）。在任何研究中，移植物失败、手法或仪器测量的松弛度均无差异。分别在1项和2项研究中，BPTB患者的临床结果评分较低和运动损失较大。在报告前膝痛的4项研究中的2项，以及记录跪痛的7项研究中的3项发现，BPTB患者中更常出现此类情况。1项研究发现HS患者再次手术率显著增加，而另一项研究在BPTB患者中发现了类似结果，还有1项研究报告BPTB患者对侧ACL撕裂显著增加。在报告骨关节炎影像学证据的5项研究中的3项指出，BPTB患者的发生率显著增加。
这项比较自体BPTB或自体HS进行ACL重建后长期结果的系统评价表明，移植物类型之间在手法/仪器测量的松弛度和移植物失败方面无显著差异。使用BPTB移植物时，长期前膝痛、跪痛增加，骨关节炎发生率更高。
