School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia.
OrthoSport Victoria Research Unit, Melbourne, Australia.
Knee Surg Sports Traumatol Arthrosc. 2021 Sep;29(9):2918-2933. doi: 10.1007/s00167-020-06311-y. Epub 2020 Oct 7.
Restoration of knee muscle strength is associated with better outcomes following anterior cruciate ligament (ACL) reconstruction, but little is known about the outcome of strength following quadriceps tendon autograft (QT) ACL reconstruction in relation to other graft types. The aim of this review was to evaluate strength outcomes of the knee extensors and knee flexors following QT ACL reconstruction compared to (1) the non-reconstructed contralateral limb and (2) alternative ACL graft types.
Four electronic databases were searched up until 21st February 2020. Summary meta-analyses were performed comparing knee strength outcomes following QT ACL reconstruction to the contralateral limb by way of limb symmetry index (LSI). Comparative meta-analyses were performed comparing QT ACL reconstruction to alternative ACL grafts for the two most frequently reported strength outcome measures which were peak knee extensor torque LSI, and peak knee flexor torque LSI at the following post-operative periods: 3, 5-8, 9-15, 24, 36-60 months.
In total, 18 studies met the inclusion criteria. Knee strength outcomes of 952 QT ACL reconstructions were included and compared to either the contralateral limb or 1 of 4 alternative ACL graft types; 245 hamstring tendon autograft (HT), 143 patellar tendon autograft (PT), 45 quadriceps tendon allograft, and 21 tibialis anterior allograft. Knee extensor strength LSI following QT ACL reconstruction did not reach 90% even at 24 months post-operatively. Conversely, knee flexor strength LSI following QT ACL reconstruction exceeded 90% at the 9-15 months post-operative period. Knee extensor strength at 5-8 months following QT ACL reconstruction appears similar to PT but weaker than HT ACL reconstruction. In addition, peak knee flexor LSI was significantly greater at 5-8 months in QT ACL reconstruction patients compared to HT patients.
The decision to utilize a QT graft for ACL reconstruction should include consideration of strength outcomes. Knee extensor strength recovery following QT ACL reconstruction appears not to be restored before 24 months.
Level IV.
膝关节肌肉力量的恢复与前交叉韧带（ACL）重建后的更好结果相关，但对于股四头肌肌腱自体移植物（QT）ACL 重建后的力量结果与其他移植物类型的关系知之甚少。本综述的目的是评估 QT ACL 重建后膝关节伸肌和屈肌的力量结果，与（1）未重建的对侧肢体和（2）其他 ACL 移植物类型相比。
四个电子数据库被搜索到 2020 年 2 月 21 日。通过肢体对称性指数（LSI）比较 QT ACL 重建后膝关节力量结果与对侧肢体的汇总荟萃分析。比较荟萃分析比较 QT ACL 重建与其他 ACL 移植物的两种最常报告的力量结果测量值，即峰值膝关节伸肌扭矩 LSI 和术后 3、5-8、9-15、24、36-60 个月时的峰值膝关节屈肌扭矩 LSI。
共有 18 项研究符合纳入标准。纳入了 952 例 QT ACL 重建的膝关节力量结果，并与对侧肢体或 4 种替代 ACL 移植物类型中的 1 种进行了比较；245 例腘绳肌腱自体移植物（HT）、143 例髌腱自体移植物（PT）、45 例四头肌肌腱同种异体移植物和 21 例胫骨前肌同种异体移植物。QT ACL 重建后甚至在术后 24 个月，膝关节伸肌力量 LSI 也未达到 90%。相反，QT ACL 重建后膝关节屈肌力量 LSI 在术后 9-15 个月时超过 90%。QT ACL 重建后 5-8 个月的膝关节伸肌力量似乎与 PT 相似，但弱于 HT ACL 重建。此外，QT ACL 重建患者在 5-8 个月时的峰值膝关节屈肌 LSI 显著大于 HT 患者。
决定使用 QT 移植物进行 ACL 重建时，应考虑力量结果。QT ACL 重建后膝关节伸肌力量的恢复似乎要到 24 个月后才能恢复。
IV 级。
