Steadman Philippon Research Institute, Vail, CO, USA.
Orthopaedic Division, Oslo University Hospital and University of Oslo, Oslo, Norway.
Knee Surg Sports Traumatol Arthrosc. 2019 Jun;27(6):1791-1809. doi: 10.1007/s00167-019-05426-1. Epub 2019 Mar 1.
Currently both autograft and allograft tissues are available for reconstruction of posterior cruciate, collateral and multi-ligament knee injuries. Decision-making is based on a complex interplay between anatomical structures, functional bundles and varying biomechanical requirements. Despite theoretically better biological healing and reduced risk of disease transmission autografts are associated with donor site morbidity as well as being limited by size and quantity. The use of allografts eliminates donor-site morbidity but raises cost and issues of clinical effectiveness. The purpose of this paper is to review current concepts and evidence for the use of allografts in primary posterior cruciate, collateral and multi-ligament reconstructions.
A narrative review of the relevant literature was conducted for PCL, collateral ligament and multi-ligament knee reconstruction. Studies were identified using a targeted and systematic search with focus on recent comparative studies and all clinical systematic reviews and meta-analyses. The rationale and principles of management underpinning the role of allograft tissue were identified and the clinical and functional outcomes were analysed. Finally, the position of postoperative physiotherapy and rehabilitation was identified.
The review demonstrated paucity in high quality and up-to-date results addressing the issue especially on collaterals and multi-ligament reconstructions. There was no significant evidence of superiority of a graft type over another for PCL reconstruction. Contemporary principles in the management of posterolateral corner, MCL and multi-ligament injuries support the use of allograft tissue.
The present review demonstrates equivalent clinical results with the use of autografts or allografts. It remains, however, difficult to generate a conclusive evidence-based approach due to the paucity of high-level research. When confronted by the need for combined reconstructions with multiple grafts, preservation of synergistic muscles, and adapted postoperative rehabilitation; the current evidence does offer support for the use of allograft tissue.
IV.
目前，可用于重建后交叉、侧副韧带和多韧带膝关节损伤的移植物包括自体移植物和同种异体移植物。决策是基于解剖结构、功能束和不同生物力学要求之间的复杂相互作用。尽管自体移植物在理论上具有更好的生物愈合能力和更低的疾病传播风险，但也存在供区发病率的问题，而且还受到大小和数量的限制。同种异体移植物的使用消除了供区发病率的问题，但增加了成本和临床效果的问题。本文旨在综述同种异体移植物在初次后交叉、侧副韧带和多韧带重建中的应用的当前概念和证据。
对 PCL、侧副韧带和多韧带膝关节重建的相关文献进行了叙述性综述。使用有针对性和系统的搜索方法确定研究，重点是最近的比较研究和所有临床系统评价和荟萃分析。确定了支持同种异体组织作用的管理原理和原则，并分析了临床和功能结果。最后，确定了术后物理治疗和康复的位置。
综述结果表明，高质量和最新的研究结果很少，特别是在侧副韧带和多韧带重建方面。在 PCL 重建中，没有证据表明一种移植物类型比另一种具有明显优势。后外侧角、MCL 和多韧带损伤的当代管理原则支持同种异体移植物的使用。
目前的综述表明，使用自体移植物或同种异体移植物的临床结果相当。然而，由于缺乏高水平的研究，仍然难以得出一个结论性的循证方法。当需要进行多韧带重建并需要多个移植物时，为了保护协同肌肉和进行适应性的术后康复，目前的证据确实支持使用同种异体移植物。
IV 级。
