Department of Orthopedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A.
Department of Orthopaedics, Seton Hall-Hackensack Meridian School of Medicine, South Orange, New Jersey, U.S.A..
Arthroscopy. 2018 Apr;34(4):1358-1365. doi: 10.1016/j.arthro.2017.11.032. Epub 2018 Feb 1.
The primary purpose of this study was to systematically review high-quality studies in the literature to compare the postoperative radiographic incidence of knee osteoarthritis (OA) after anterior cruciate ligament reconstruction (ACLR) with bone-patellar tendon-bone (BPTB) versus hamstring tendon (HT) autograft. The secondary purpose of this study was to compare other symptoms of postoperative knee OA between these 2 groups through patient-reported outcome scores and knee range of motion.
A systematic review was performed by searching PubMed, Embase, and Cochrane Library to locate randomized controlled trials that compared postoperative progression of knee OA in patients who had undergone ACLR with BPTB versus HT autograft. Search terms used were "anterior cruciate ligament reconstruction," "patellar tendon," "hamstring," "randomized," and "osteoarthritis." Patients were assessed based on radiographic evaluation (Kellgren-Lawrence, Ahlbäck, Fairbank, and the Objective International Knee Documentation Committee scales), patient-reported outcome scores (Knee Injury and Osteoarthritis Outcome Score and visual analog scale scores), graft failure, and active knee flexion and extension deficit.
Eight studies (6 Level I, 2 Level II) were identified that met inclusion criteria, including a total of 237 and 268 nonoverlapping patients who had undergone ACLR with BPTB and HT autograft, respectively, with a mean follow-up of 11.5 years (range, 3-16 years). Graft failure was experienced by 7.0% of patients in each group (P = .99). A Kellgren-Lawrence grade ≥2 was found in 52.0% and 51.0% of BPTB and HT autograft patients, respectively (P = .85). An Ahlbäck and Fairbank grade ≥2 was found in 5.0% and 8.4% of BPTB and HT autograft patients, respectively (P = .36). There were no significant differences in any patient-reported outcomes between groups within any study.
Patients undergoing ACLR with BPTB autograft or HT autograft can be expected to experience a similar incidence of postoperative knee OA at long-term follow-up.
Level II, systematic review of Level I and II studies.
本研究的主要目的是系统地回顾文献中的高质量研究，以比较前交叉韧带重建（ACLR）后使用骨-髌腱-骨（BPTB）与腘绳肌腱（HT）自体移植物的术后膝关节骨关节炎（OA）的放射学发生率。本研究的次要目的是通过患者报告的结果评分和膝关节活动范围来比较这两组术后膝关节 OA 的其他症状。
通过搜索 PubMed、Embase 和 Cochrane 图书馆，我们进行了系统评价，以查找比较使用 BPTB 与 HT 自体移植物进行 ACLR 后患者的术后膝关节 OA 进展的随机对照试验。使用的搜索词是“前交叉韧带重建”、“髌腱”、“腘绳肌”、“随机”和“骨关节炎”。根据放射学评估（Kellgren-Lawrence、Ahlbäck、Fairbank 和客观国际膝关节文献委员会量表）、患者报告的结果评分（膝关节损伤和骨关节炎结果评分和视觉模拟评分）、移植物失败以及主动膝关节屈伸缺陷对患者进行评估。
共确定了 8 项符合纳入标准的研究（6 项 I 级，2 项 II 级），其中分别包括 237 例和 268 例不重叠的接受 BPTB 和 HT 自体移植物 ACLR 的患者，平均随访时间为 11.5 年（范围为 3-16 年）。两组患者的移植物失败率分别为 7.0%（P=.99）。BPTB 和 HT 自体移植物患者的 Kellgren-Lawrence 分级≥2 分别为 52.0%和 51.0%（P=.85）。Ahlbäck 和 Fairbank 分级≥2 的患者分别为 5.0%和 8.4%（P=.36）。在任何研究中，两组患者的任何患者报告结果均无显著差异。
长期随访时，接受 BPTB 自体移植物或 HT 自体移植物进行 ACLR 的患者可预期出现相似的术后膝关节 OA 发生率。
II 级，I 级和 II 级研究的系统评价。
