Tan Si Heng Sharon, Lau Bernard Puang Huh, Krishna Lingaraj
Department of Orthopaedic Surgery, National University Hospital Sports Centre, National University Health System, Singapore.
J Knee Surg. 2019 Aug;32(8):770-787. doi: 10.1055/s-0038-1669916. Epub 2018 Sep 13.
The current review aims to compare the outcomes of anterior cruciate ligament (ACL) reconstruction in the female population after patellar-tendon-bone and hamstring grafts. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. All original randomized controlled trials and prospective cohort studies that compared clinical outcomes after female ACL reconstruction using hamstring versus patellar-tendon-bone grafts were included. All clinical outcomes reported by three or more studies were included. Fifteen publications, with 948 female patients, were included. Most outcomes were reported to have no significant graft differences by all studies that reported the outcome. These included all the outcomes for objective knee scores (International Knee Documentation Committee [IKDC] objective knee score), neuromuscular testing (quadriceps strength, hamstring strength, and single hop test), graft rupture or failure, and subjective knee scores (Lysholm score and IKDC subjective knee score). The pivot shift test, flexion deficit, and presence of crepitus were also reported to have no significant graft differences by all studies. Some studies reported a significant difference in anteroposterior laxity (Lachman's test and instrumented laxity), range of motion deficits (extension deficit), and sports and activity level (Tegner score). However, these statistically significant differences were noted to be clinically insignificant due to the normal population variation or standard error of measurement of these tools of evaluation. Patients reconstructed with patellar-tendon-bone grafts have a higher risk of kneeling pain. There was no significant difference in the incidence of crepitus. Most of the outcomes following female ACL reconstructions showed no clinically and statistically significant difference when either patellar-tendon-bone or hamstring autograft was used. These included outcomes for anteroposterior laxity, objective knee scores, neuromuscular testing, graft rupture or failure, subjective knee scores, sports and activity level, and crepitus. This a level II study.
本综述旨在比较女性人群中髌腱-骨移植与腘绳肌移植后前交叉韧带（ACL）重建的结果。本综述按照系统评价和Meta分析的首选报告项目指南进行。纳入了所有比较女性ACL重建中使用腘绳肌移植与髌腱-骨移植后临床结果的原始随机对照试验和前瞻性队列研究。纳入了三项或更多研究报告的所有临床结果。共纳入15篇出版物，涉及948例女性患者。大多数结果在所有报告该结果的研究中均显示移植之间无显著差异。这些结果包括客观膝关节评分（国际膝关节文献委员会[IKDC]客观膝关节评分）、神经肌肉测试（股四头肌力量、腘绳肌力量和单跳测试）、移植破裂或失败以及主观膝关节评分（Lysholm评分和IKDC主观膝关节评分）的所有结果。所有研究还报告，轴移试验、屈曲受限和弹响的存在在移植之间也无显著差异。一些研究报告在前后向松弛度（Lachman试验和仪器测量的松弛度）、活动范围受限（伸展受限）以及运动和活动水平（Tegner评分）方面存在显著差异。然而，由于这些评估工具的正常人群变异或测量标准误差，这些统计学上的显著差异在临床上并无意义。接受髌腱-骨移植重建的患者出现跪痛的风险更高。弹响的发生率无显著差异。女性ACL重建后，使用髌腱-骨或腘绳肌自体移植时，大多数结果在临床和统计学上均无显著差异。这些结果包括前后向松弛度、客观膝关节评分、神经肌肉测试、移植破裂或失败、主观膝关节评分、运动和活动水平以及弹响。这是一项II级研究。
