Department of Orthopaedics, King Saud University, Riyadh, Saudi Arabia.
Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):288-297. doi: 10.1007/s00167-021-06503-0. Epub 2021 Feb 23.
Multi-stranded hamstring-tendon autografts have been widely used for anterior cruciate ligament reconstruction (ACLR) surgeries. Recently, smaller diameter hamstring autografts have been linked with the risk of failure or graft rupture. However, there is limited evidence concerning the optimal diameter of the hamstring autografts for ACLR. The current systematic review and meta-analysis analysed the association of ACLR failure with the diameter of hamstring autografts.
A systematic search of three major scientific databases (Pubmed, EMBASE, and Cochrane library) was conducted to identify studies that presented ACLR failure-related outcomes with different diameters of hamstring autografts. The pooled data from the included studies were analysed to investigate the association between ACLR failure and the cut-off diameters of 6, 7, 8, and 9 mm. Subgroup analyses based on the level of evidence and follow-up duration were also performed at each cut-off diameter.
Of the 2282 studies screened, 16 reported failure rates with hamstring autografts of different diameters, 15 of which were included in the meta-analysis. A graft diameter ≥ 7 mm was associated with significantly lower ACLR failure rates than a graft diameter < 7 mm (p = 0.005), based on pooled data of 19,799 cases. Age < 20 years and higher physical activity were associated with significantly higher ACLR failure rates.
The current systematic review suggests that the hamstring graft diameter for ACLR should be more than 7 mm considering the significantly higher failure rates with graft diameters less than 7 mm.
Level IV.
多股腘绳肌腱自体移植物已广泛应用于前交叉韧带重建（ACL）手术。最近，较小直径的腘绳肌腱自体移植物与失败或移植物破裂的风险有关。然而，关于 ACLR 中腘绳肌腱自体移植物的最佳直径的证据有限。本系统评价和荟萃分析分析了 ACLR 失败与腘绳肌腱自体移植物直径的关系。
对三个主要科学数据库（Pubmed、EMBASE 和 Cochrane 图书馆）进行系统检索，以确定报告不同腘绳肌腱自体移植物直径与 ACLR 失败相关结局的研究。对纳入研究的汇总数据进行分析，以研究 ACLR 失败与 6、7、8 和 9mm 截止直径之间的关系。还根据证据水平和随访时间在每个截止直径进行了亚组分析。
在筛选出的 2282 项研究中，有 16 项报告了不同直径腘绳肌腱自体移植物的失败率，其中 15 项被纳入荟萃分析。根据 19799 例的汇总数据，直径≥7mm 的移植物与直径<7mm 的移植物相比，ACL 重建失败率显著降低（p=0.005）。<20 岁和更高的体力活动与 ACLR 失败率显著增加有关。
基于直径<7mm 的移植物失败率显著更高，本系统评价提示 ACLR 中腘绳肌腱移植物直径应大于 7mm。
IV 级。
