Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, Luxembourg, Luxembourg.
Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg.
Knee Surg Sports Traumatol Arthrosc. 2022 Dec;30(12):4214-4224. doi: 10.1007/s00167-022-07071-7. Epub 2022 Aug 2.
Different graft options are available for the reconstruction of lateral ankle ligaments to treat chronic ankle instability (CAI), which fall in two categories: allografts and autografts. This study aims to provide an updated comparison of the clinical outcomes after stabilisation procedures using allografts and autografts, to correctly advise the clinician during the choice of the best material to be used for the reconstruction of the lateral ligamentous complex of the ankle.
A systematic review was performed to analyse the use of autografts and allografts for anatomic reconstruction of the lateral ligamentous complex of the ankle in CAI patients. The presence of a postoperative assessment through outcome measures with proofs of validation in the CAI population or patient's subjective evaluation on the treatment were necessary for inclusion. The quality of the included studies was assessed through the modified Coleman Methodology Score (mCMS). Relevant clinical outcome data were pooled to provide a synthetic description of the results in different groups or after different procedures.
Twenty-nine studies (autograft: 19; allograft: 9; both procedures: 1) accounting for 930 procedures (autograft: 616; allograft: 314) were included. The average mCMS was 55.9 ± 10.5 points. The Karlsson-Peterson scale was the most frequently reported outcome scale, showing a cumulative average post- to preoperative difference of 31.9 points in the autograft group (n = 379, 33.8 months follow-up) and of 35.7 points in the allograft group (n = 227, 25.8 months follow-up). Patient satisfaction was good or excellent in 92.8% of autograft (n = 333, 65.2 months follow-up) and in 92.3% of allograft procedures (n = 153, 25.0 months follow-up). Return to activity after surgery and recurrence of instability were variably reported across the studies with no clear differences between allograft and autograft highlighted by these outcomes.
The systematic analysis of validated CAI outcome measures and the patient's subjective satisfaction does not support a specific choice between autograft and allograft for the reconstruction of the ankle lateral ligamentous complex in CAI patients. Both types of grafts were associated to a postoperative Karlsson-Peterson score superior to 80 points and to a similar rate of patient's subjective satisfaction.
Level IV.
为了治疗慢性踝关节不稳定（CAI），有多种可供选择的移植物来重建外侧踝关节韧带，这些移植物可分为同种异体移植物和自体移植物。本研究旨在提供同种异体移植物和自体移植物在稳定术后临床结果的最新比较，以便在选择用于重建踝关节外侧韧带复合体的最佳材料时为临床医生提供正确的建议。
我们进行了系统评价，以分析同种异体移植物和自体移植物在 CAI 患者中用于解剖重建外侧踝关节韧带复合体的应用。需要存在通过 CAI 人群中的结果测量进行的术后评估，或者患者对治疗的主观评价，以纳入研究。通过改良 Coleman 方法学评分（mCMS）评估纳入研究的质量。汇总了相关的临床结果数据，以提供不同组或不同手术程序后的结果综合描述。
共纳入 29 项研究（自体移植物：19 项；同种异体移植物：9 项；两种手术程序：1 项），共涉及 930 例手术（自体移植物：616 例；同种异体移植物：314 例）。平均 mCMS 为 55.9±10.5 分。Karlsson-Peterson 量表是最常报告的结果量表，显示自体移植物组（n=379，33.8 个月随访）术后至术前的平均差值为 31.9 分，同种异体移植物组（n=227，25.8 个月随访）为 35.7 分。自体移植物组（n=333，65.2 个月随访）的患者满意度为 92.8%，同种异体移植物组（n=153，25.0 个月随访）为 92.3%，均为良好或优秀。术后活动恢复和不稳定复发在各项研究中报告不一，同种异体移植物和自体移植物之间没有明显差异。
对 CAI 结果测量和患者主观满意度进行系统分析，并不支持在 CAI 患者中重建外侧踝关节韧带复合体时对自体移植物和同种异体移植物进行特定选择。两种类型的移植物都与术后 Karlsson-Peterson 评分均大于 80 分和相似的患者满意度相关。
IV 级。
