Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.
Medical Imaging Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
Am J Sports Med. 2022 Oct;50(12):3425-3439. doi: 10.1177/03635465211030259. Epub 2021 Sep 8.
The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable.
Compared with bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts, the quadriceps tendon (QT) autograft has comparable graft survival as well as clinical function and pain outcomes.
Meta-analysis; Level of evidence, 4.
A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library to July 2020. Randomized controlled trials (RCTs) and observational studies reporting comparisons of QT versus BPTB or HT autografts for ACL reconstruction were included. All analyses were stratified according to study design: RCTs or observational studies.
A total of 24 studies were included: 7 RCTs and 17 observational studies. The 7 RCTs included 388 patients, and the 17 observational studies included 19,196 patients. No significant differences in graft failure ( = .36), the International Knee Documentation Committee (IKDC) subjective score ( = .39), or the side-to-side difference in stability ( = .60) were noted between QT and BPTB autografts. However, a significant reduction in donor site morbidity was noted in the QT group compared with the BPTB group (risk ratio [RR], 0.17 [95% CI, 0.09-0.33]; < .001). No significant differences in graft failure ( = .57), the IKDC subjective score ( = .25), or the side-to-side stability difference ( = .98) were noted between QT and HT autografts. However, the QT autograft was associated with a significantly lower rate of donor site morbidity than the HT autograft (RR, 0.60 [95% CI, 0.39-0.93]; = .02). A similar graft failure rate between the QT and control groups was observed after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. However, a significantly lower rate of donor site morbidity was observed in the QT group compared with the control group after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. No difference in effect estimates was seen between RCTs and observational studies.
The QT autograft had comparable graft survival, functional outcomes, and stability outcomes compared with BPTB and HT autografts. However, donor site morbidity was significantly lower with the QT autograft than with BPTB and HT autografts.
前交叉韧带（ACL）重建中最佳的自体移植物类型仍存在争议。
与骨-髌腱-骨（BPTB）和腘绳肌腱（HT）自体移植物相比，四头肌腱（QT）自体移植物具有相似的移植物存活率以及临床功能和疼痛结局。
荟萃分析；证据水平，4 级。
在 PubMed、Embase、Scopus 和 Cochrane 图书馆中进行了系统的文献检索，检索时间截至 2020 年 7 月。纳入了比较 QT 与 BPTB 或 HT 自体移植物用于 ACL 重建的随机对照试验（RCT）和观察性研究。所有分析均根据研究设计进行分层：RCT 或观察性研究。
共纳入 24 项研究：7 项 RCT 和 17 项观察性研究。7 项 RCT 纳入 388 例患者，17 项观察性研究纳入 19196 例患者。QT 与 BPTB 自体移植物相比，在移植物失败（ =.36）、国际膝关节文献委员会（IKDC）主观评分（ =.39）或稳定性的侧-侧差异（ =.60）方面无显著差异。然而，与 BPTB 组相比，QT 组的供区发病率显著降低（风险比 [RR]，0.17 [95%CI，0.09-0.33]； <.001）。QT 与 HT 自体移植物相比，在移植物失败（ =.57）、IKDC 主观评分（ =.25）或稳定性的侧-侧差异（ =.98）方面无显著差异。然而，与 HT 自体移植物相比，QT 自体移植物的供区发病率显著降低（RR，0.60 [95%CI，0.39-0.93]； =.02）。在早期和晚期完全负重、早期和晚期全关节活动范围以及使用带骨栓的 QT 自体移植物和所有 QT 软组织移植物后，QT 与对照组的移植物失败率相似。然而，与对照组相比，QT 组的供区发病率在早期和晚期完全负重、早期和晚期全关节活动范围以及使用带骨栓的 QT 自体移植物和所有 QT 软组织移植物后均显著降低。在 RCT 和观察性研究之间未观察到效应估计值的差异。
QT 自体移植物与 BPTB 和 HT 自体移植物相比，具有相似的移植物存活率、功能结局和稳定性结局。然而，与 BPTB 和 HT 自体移植物相比，QT 自体移植物的供区发病率显著降低。
