Liukkonen Rasmus J, Ponkilainen Ville T, Reito Aleksi
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland.
Orthop J Sports Med. 2022 Aug 5;10(8):23259671221110191. doi: 10.1177/23259671221110191. eCollection 2022 Aug.
Numerous studies, including randomized controlled trials (RCTs), have been published on the optimal graft choice for primary anterior cruciate ligament (ACL) reconstruction.
To review existing studies to investigate whether advances in orthopaedics have affected revision rates after primary ACL reconstruction.
Systematic review; Level of evidence, 4.
The PubMed database was searched from inception to December 31, 2020, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Patient series, observational studies, clinical trials, and registry-based studies investigating primary ACL reconstruction were included, as were high-quality RCTs from an additional study. The minimum required follow-up time for inclusion was 1 year. The primary outcome measure was the pooled prevalence of revision ACL reconstruction. The effect of the year the surgery was performed on revision rates was evaluated with metaregression analysis. All graft types were analyzed simultaneously, and all analyses were repeated separately for each graft type.
Overall, 330 articles with 52,878 patients were included, with a median patient age of 28 years (range, 15-57 years). The primary ACL reconstructions were performed between 1969 and 2018. At a median of 2.3 years of follow-up, the overall revision rate was 3.14% (95% CI, 2.76% to 3.56%); it was 2.71% (95% CI, 2.25% to 3.27%) for hamstring autografts, 2.38% (95% CI, 1.82% to 3.11%) for bone-patellar tendon-bone (BPTB) autografts, and 5.24% (95% CI, 4.02% to 6.80%) for other graft types. For hamstring grafts, the revision rate increased over time (year of surgery), with a 0.0434 (95% CI, 0.0150 to 0.0718) increase effect in the logit-transformed scale for every additional year. There was a slight decrease in revision rates for BPTB (β = -0.0049; 95% CI, -0.0352 to 0.0254) and other graft types (β = -0.0306; 95% CI, -0.0608 to -0.0005) over time; however, confidence intervals for BPTB included the zero change.
Based on this systematic review and meta-analysis, ACL reconstruction is a reliable procedure with overall low historical revision rates. BPTB autograft had the lowest revision rate and a slightly decreasing trend of failures during the past 45 years, although both BPTB and hamstring autografts are reliable graft choices.
包括随机对照试验（RCT）在内，已有大量关于初次前交叉韧带（ACL）重建最佳移植物选择的研究发表。
回顾现有研究，以调查骨科领域的进展是否影响初次ACL重建后的翻修率。
系统评价；证据等级，4级。
按照PRISMA（系统评价和Meta分析的首选报告项目）指南，检索PubMed数据库自建库至2020年12月31日的文献。纳入研究初次ACL重建的患者系列研究、观察性研究、临床试验和基于注册登记的研究，以及另一项研究中的高质量RCT。纳入研究的最短随访时间为1年。主要结局指标为ACL重建翻修的合并患病率。采用Meta回归分析评估手术年份对翻修率的影响。同时分析所有移植物类型，并对每种移植物类型分别重复所有分析。
共纳入330篇文章，涉及52878例患者，患者年龄中位数为28岁（范围15 - 57岁）。初次ACL重建手术时间为1969年至2018年。随访时间中位数为2.3年，总体翻修率为3.14%（95%CI，2.76%至3.56%）；腘绳肌自体移植物翻修率为2.71%（95%CI，2.25%至3.27%），髌腱-骨（BPTB）自体移植物翻修率为2.38%（95%CI，1.82%至3.11%），其他移植物类型翻修率为%（95%CI，4.02%至6.80%）。对于腘绳肌移植物，翻修率随时间（手术年份）增加，在对数转换尺度上，每增加一年，效应增加%（95%CI，0.0150至0.0718）。BPTB（β = -0.0049；95%CI，-0.0352至0.0254）和其他移植物类型（β = -0.0306；95%CI，-0.0608至-0.0005）的翻修率随时间略有下降；然而，BPTB的置信区间包括零变化。
基于本系统评价和Meta分析，ACL重建是一种可靠的手术，历史总体翻修率较低。BPTB自体移植物翻修率最低，在过去45年中失败率呈轻微下降趋势，尽管BPTB和腘绳肌自体移植物都是可靠的移植物选择。
