Hexter A T, Thangarajah T, Blunn G, Haddad F S
Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, and Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK and NIHR University College London Hospitals Biomedical Research Centre, UK.
Bone Joint J. 2018 Mar 1;100-B(3):271-284. doi: 10.1302/0301-620X.100B3.BJJ-2017-0733.R2.
The success of anterior cruciate ligament reconstruction (ACLR) depends on osseointegration at the graft-tunnel interface and intra-articular ligamentization. Our aim was to conduct a systematic review of clinical and preclinical studies that evaluated biological augmentation of graft healing in ACLR.
In all, 1879 studies were identified across three databases. Following assessment against strict criteria, 112 studies were included (20 clinical studies; 92 animal studies).
Seven categories of biological interventions were identified: growth factors, biomaterials, stem cells, gene therapy, autologous tissue, biophysical/environmental, and pharmaceuticals. The methodological quality of animal studies was moderate in 97%, but only 10% used clinically relevant outcome measures. The most interventions in clinical trials target the graft-tunnel interface and are applied intraoperatively. Platelet-rich plasma is the most studied intervention, but the clinical outcomes are mixed, and the methodological quality of studies was suboptimal. Other biological therapies investigated in clinical trials include: remnant-augmented ACLR; bone substitutes; calcium phosphate-hybridized grafts; extracorporeal shockwave therapy; and adult autologus non-cultivated stem cells.
There is extensive preclinical research supporting the use of biological therapies to augment ACLR. Further clinical studies that meet the minimum standards of reporting are required to determine whether emerging biological strategies will provide tangible benefits in patients undergoing ACLR. Cite this article: Bone Joint J 2018;100-B:271-84.
前交叉韧带重建术（ACLR）的成功取决于移植物与骨隧道界面的骨整合以及关节内韧带化。我们的目的是对评估ACLR中移植物愈合生物增强作用的临床和临床前研究进行系统评价。
通过三个数据库共检索到1879项研究。根据严格标准进行评估后，纳入112项研究（20项临床研究；92项动物研究）。
确定了七类生物干预措施：生长因子、生物材料、干细胞、基因治疗、自体组织、生物物理/环境因素以及药物。97%的动物研究方法学质量中等，但只有10%使用了临床相关的结局指标。临床试验中大多数干预措施针对移植物与骨隧道界面，且在术中应用。富血小板血浆是研究最多的干预措施，但临床结果不一，研究的方法学质量欠佳。临床试验中研究的其他生物疗法包括：残余增强型ACLR；骨替代物；磷酸钙杂交移植物；体外冲击波疗法；以及成人自体未培养干细胞。
有大量临床前研究支持使用生物疗法增强ACLR。需要进一步开展符合最低报告标准的临床研究，以确定新出现的生物策略是否会给接受ACLR的患者带来切实益处。引用本文：《骨与关节杂志》2018年；100 - B：271 - 84。
