Division of Orthopaedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada.
J ISAKOS. 2022 Feb;7(1):27-34. doi: 10.1016/j.jisako.2021.08.002. Epub 2021 Oct 4.
The posterior cruciate ligament (PCL) is involved in almost one-third of all knee injuries. Surgical management of PCL injuries is currently controversial, and no single graft material is determined as superior in primary PCL reconstruction. A growing body of literature has demonstrated the safety and versatility of the quadriceps tendon (QT) autograft in arthroscopic knee ligament reconstruction.
The objective of the study was to assess the QT autograft for use in primary PCL reconstruction with a focus on complication rates, revision rates, and functional outcomes.
The online databases Medline, Embase, Web of Science, and CENTRAL were searched on April 30, 2020. Retrieved records were screened by two independent reviewers. Eligible studies assessed the QT autograft in skeletally mature participants undergoing primary PCL reconstruction. Studies of multiligamentous repairs and revisions were excluded. A narrative summary of results from individual studies is presented.
Six articles met inclusion criteria with n = 119 participants (21% female) and a follow-up range from 12 months to 84 months. Complication rates ranged from 13% to 65% and included moderate (n = 4) and mild (n = 4) knee pain, reflex sympathetic dystrophy (n = 3), joint space narrowing (n = 3), superficial wound infections (n = 2), complex regional pain syndrome (n = 2), and flexion deficiency (n = 2). Revision rates ranged from 0% to 15% and included hardware removal (n = 4), manipulation under anaesthesia (n = 2), arthroscopic arthrolysis (n = 2), and arthroscopic refixation (n = 2). Subjective International Knee Documentation Committee scores increased from a preoperative range of 37.7 ± 21.4 to 39.5 ± 21 to a postoperative range of 74.5 ± 17.7 to 84.7. Lysholm scores, Tegner activity scores, and posterior tibial laxity also demonstrated improvements postoperatively. No statistically significant differences were reported in the study that compared the QT autograft with the hamstring tendon autograft.
This systematic review reported functional outcomes and complication rates of a small QT autograft sample that were comparable with other graft materials used in PCL reconstruction. Heterogeneity of the included studies and reported outcomes precluded meta-analysis. Future studies of better methodological quality and larger sample sizes need to be conducted before the QT autograft may be concluded as safe and effective in primary PCL reconstruction.
IV.
后交叉韧带（PCL）几乎涉及所有膝关节损伤的三分之一。PCL 损伤的手术治疗目前存在争议，没有任何单一的移植物材料被确定为原发性 PCL 重建中的优势。越来越多的文献证明了四头肌腱（QT）自体移植物在关节镜下膝关节韧带重建中的安全性和多功能性。
本研究旨在评估 QT 自体移植物在原发性 PCL 重建中的应用，重点关注并发症发生率、翻修率和功能结果。
2020 年 4 月 30 日，在线数据库 Medline、Embase、Web of Science 和 CENTRAL 进行了检索。由两名独立评审员筛选检索到的记录。符合条件的研究评估了 QT 自体移植物在接受原发性 PCL 重建的骨骼成熟参与者中的应用。排除多韧带修复和翻修的研究。从个别研究中呈现结果的叙述性总结。
有 6 篇文章符合纳入标准，共纳入 119 名参与者（21%为女性），随访时间为 12 个月至 84 个月。并发症发生率为 13%至 65%，包括中度（n=4）和轻度（n=4）膝关节疼痛、反射性交感神经营养不良（n=3）、关节间隙变窄（n=3）、浅表性伤口感染（n=2）、复杂性区域疼痛综合征（n=2）和屈曲不足（n=2）。翻修率为 0%至 15%，包括去除内固定物（n=4）、麻醉下手法复位（n=2）、关节镜下关节松解术（n=2）和关节镜下重新固定术（n=2）。国际膝关节文献委员会主观评分从术前的 37.7±21.4 增加到术后的 39.5±21，再增加到 74.5±17.7 到 84.7。Lysholm 评分、Tegner 活动评分和胫骨后向松弛度也显示出术后改善。在将 QT 自体移植物与腘绳肌腱自体移植物进行比较的研究中，没有报告统计学上显著的差异。纳入研究的异质性和报告结果排除了荟萃分析。在 QT 自体移植物可被认为在原发性 PCL 重建中安全有效之前，需要进行具有更高方法学质量和更大样本量的未来研究。
IV。
