Department of Orthopaedics, Tulane University, New Orleans, Louisiana, USA.
School of Medicine, Tulane University, New Orleans, Louisiana, USA.
Am J Sports Med. 2023 Jul;51(9):2498-2505. doi: 10.1177/03635465221095233. Epub 2022 Jun 6.
The quadriceps tendon (QT) autograft is a commonly used and effective graft option for anterior cruciate ligament reconstruction (ACLR). Surgical techniques vary, and there is no current standard of care for management of the QT autograft harvest site.
To examine the literature on patient-reported outcomes and complications after ACLR with a QT autograft and to further clarify the frequency with which the harvest site is closed and potential biomechanical implications.
Systematic review; Level of evidence, 4.
A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using multiple medical databases. Level 1 to 4 studies on patients undergoing ACLR with a QT autograft were included. There were 2 independent reviewers who analyzed all studies. Study quality was analyzed using the methodological index for non-randomized studies checklist.
Overall, 13 studies with a total of 650 patients were included. The mean patient age for all studies was 31 years (range, 14-59 years) with a mean follow-up of 21.2 months (range, 6-84 months). Of the 13 studies, 12 studies (92%) documented patient sex, comprising 331 female patients (55%) and 274 male patients (45%). There were 8 studies (62%) that reported the use of a bony QT autograft in 273 patients, and 5 studies (38%) reported the use of a soft tissue QT autograft in 377 patients. The graft length harvested was most commonly 7 to 8 cm, while the tendon width harvested was 10 mm. Moreover, 5 studies (38%) did not discuss closure of the harvest site, while 2 studies (15%) only closed the harvest site if a capsular rent was present. The surgical technique for harvest-site closure varied when reported in 7 studies (54%). Good to excellent clinical outcomes were reported in 80% of patients when the harvest site was closed.
Based on the results of this study, there is no consensus on whether the QT defect should be closed after harvesting the graft for ACLR. It has been reported that closure of the harvest site is performed if there is a capsular rent present. Several techniques are utilized to close the QT autograft harvest site; however, it is unclear if there is a difference in outcomes based on the technique used. Future studies should further clarify whether there are any biomechanical and clinical advantages to closing the QT autograft harvest site.
四头肌腱（QT）自体移植物是前交叉韧带重建（ACLR）中常用且有效的移植物选择。手术技术多种多样，目前对于 QT 自体移植物采集部位的处理尚无标准的护理方法。
检查 ACLR 中使用 QT 自体移植物后患者报告的结果和并发症的文献，并进一步阐明采集部位闭合的频率以及潜在的生物力学意义。
系统评价；证据水平，4 级。
根据 PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价，使用多个医学数据库。纳入接受 QT 自体移植物 ACLR 的 1 级至 4 级研究。有 2 名独立的审查员分析所有研究。使用非随机研究方法学指数清单分析研究质量。
总体而言，纳入了 13 项共 650 例患者的研究。所有研究的平均患者年龄为 31 岁（范围，14-59 岁），平均随访时间为 21.2 个月（范围，6-84 个月）。在 13 项研究中，有 12 项研究（92%）记录了患者的性别，包括 331 名女性患者（55%）和 274 名男性患者（45%）。有 8 项研究（62%）报告在 273 例患者中使用了骨 QT 自体移植物，5 项研究（38%）报告在 377 例患者中使用了软组织 QT 自体移植物。采集的移植物长度最常见为 7 至 8 cm，而采集的肌腱宽度为 10 mm。此外，有 5 项研究（38%）未讨论采集部位的闭合，而有 2 项研究（15%）仅在存在囊状撕裂时才闭合采集部位。在 7 项研究（54%）中报告了采集部位闭合的手术技术各不相同。当采集部位闭合时，80%的患者报告了良好至优秀的临床结果。
根据本研究的结果，对于 ACLR 中采集移植物后是否应闭合 QT 缺陷尚无共识。如果存在囊状撕裂，有报道称会闭合采集部位。有几种技术用于闭合 QT 自体移植物采集部位；然而，根据使用的技术，尚不清楚结果是否存在差异。未来的研究应进一步阐明闭合 QT 自体移植物采集部位在生物力学和临床方面是否有任何优势。
