Orthopaedic Sports Medicine (UTOSM), University of Toronto, Women's College Hospital, Toronto, ON, Canada ; and.
Department of Surgery, University of Toronto, Toronto, ON, Canada .
Clin J Sport Med. 2021 Jul 1;31(4):392-399. doi: 10.1097/JSM.0000000000000765.
There is growing enthusiasm for the increased use of quadriceps tendon (QT) autograft for primary anterior cruciate ligament reconstruction (ACLR). The purpose of this analysis was to synthesize and quantitatively assess the available evidence comparing QT autograft with hamstring tendon (HT) and bone-patellar tendon-bone (BPTB) autografts, regarding functional outcomes, knee stability, anterior knee pain, and revision rates.
A search in MEDLINE, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials for eligible studies up to May 2018 was conducted. Two reviewers selected studies based on inclusion criteria and assessed methodological quality. Outcomes analyzed were anterior knee pain, graft failure rates, knee stability, functional outcomes, and adverse events. Pooled analyses were performed for continuous and dichotomous variables where appropriate.
Ten studies (1 randomized trial and 9 nonrandomized cohorts) met our inclusion criteria, which included 1398 patients. The analysis showed no statistical difference in anterior knee pain when comparing QT and HT autografts, but a significant difference between QT and BPTB autografts [odds ratio, 0.15 (95% confidence interval, 0.08-0.27); P < 0.001]. There were no differences between all 3 autografts in revision rates, knee stability, and patient-reported functional outcomes.
Quadriceps tendon autograft is a suitable graft alternative for primary ACLR, as it achieves good clinical outcomes with a low incidence of anterior knee pain. Given the limited quality of the included studies, there is a need for a well-designed multicenter randomized control trial comparing QT autograft with other primary ACL autografts to confirm our findings.
Level IV systematic review.
人们对增加使用股四头肌肌腱（QT）自体移植物进行初次前交叉韧带重建（ACLR）的兴趣日益浓厚。本分析的目的是综合并定量评估现有的证据，比较 QT 自体移植物与腘绳肌腱（HT）和骨-髌腱-骨（BPTB）自体移植物在功能结果、膝关节稳定性、前膝疼痛和翻修率方面的差异。
对截至 2018 年 5 月的 MEDLINE、EMBASE、PubMed 和 Cochrane 对照试验中心注册库中的合格研究进行了搜索。两名审查员根据纳入标准选择研究，并评估了方法学质量。分析的结果包括前膝疼痛、移植物失败率、膝关节稳定性、功能结果和不良事件。在适当的情况下，对连续和二分类变量进行了汇总分析。
有 10 项研究（1 项随机试验和 9 项非随机队列研究）符合我们的纳入标准，共纳入 1398 例患者。分析结果显示，QT 和 HT 自体移植物在膝关节前痛方面无统计学差异，但 QT 和 BPTB 自体移植物之间存在显著差异[比值比，0.15（95%置信区间，0.08-0.27）；P<0.001]。在翻修率、膝关节稳定性和患者报告的功能结果方面，所有 3 种自体移植物之间均无差异。
QT 自体移植物是初次 ACLR 的一种合适的移植物替代物，因为它具有良好的临床效果，且膝关节前痛的发生率较低。鉴于纳入研究的质量有限，需要进行一项精心设计的多中心随机对照试验，比较 QT 自体移植物与其他初次 ACL 自体移植物，以确认我们的发现。
IV 级系统评价。
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