自体移植和未辐照同种异体移植用于前交叉韧带重建的临床结果和移植物失败率相似：一项更新的系统评价
Autograft and Nonirradiated Allograft for Anterior Cruciate Ligament Reconstruction Demonstrate Similar Clinical Outcomes and Graft Failure Rates: An Updated Systematic Review.
作者信息
Dhillon Jaydeep, Kraeutler Matthew J, Belk John W, McCarty Eric C, McCulloch Patrick C, Scillia Anthony J
机构信息
Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, U.S.A.
Department of Orthopaedic Surgery, St. Joseph's University Medical Center, Paterson, New Jersey, U.S.A.
出版信息
Arthrosc Sports Med Rehabil. 2022 Jun 6;4(4):e1513-e1521. doi: 10.1016/j.asmr.2022.04.008. eCollection 2022 Aug.
PURPOSE
To perform an updated systematic review comparing the clinical outcomes of autograft versus nonirradiated allograft for anterior cruciate ligament reconstruction (ACLR).
METHODS
A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify comparative studies directly comparing outcomes of primary ACLR with autograft versus nonirradiated allograft with a minimum 2-year follow-up. The search terms used were: "anterior cruciate ligament" AND autograft AND allograft AND (irradiation OR non-irradiated). Patients were evaluated based on graft failure rates, the Objective International Knee Documentation Committee (IKDC) score, anteroposterior laxity, and patient-reported outcomes (Subjective IKDC score, the visual analog scale [VAS], the Cincinnati Knee Rating System, Lysholm, and Tegner scores). Risk of bias was assessed using the ROBINS-I and Cochrane Collaboration's risk of bias tool for non-randomized and randomized studies, respectively.
RESULTS
Sixteen studies (3 Level I, 7 Level II, 6 Level III) met inclusion criteria, including a total of 15,502 patients undergoing ACLR with autograft and 1,577 with nonirradiated allograft. The average follow-up ranged from 24.0 to 132.0 months. Graft failure ranged from 0% to 9.4% of patients in the autograft group and 0% to 26.5% in the allograft group. Two studies showed greater failure rates among younger patients in the allograft group. There were no significant differences between the Objective IKDC score, anteroposterior laxity, or patient-reported outcomes between the groups within any of the included studies ( > .05).
CONCLUSIONS
Autograft and nonirradiated allograft for primary ACLR demonstrate similar patient-reported outcomes and graft failure rates.
LEVEL OF EVIDENCE
III, systematic review of level I-III studies.
目的
进行一项更新的系统评价，比较自体移植物与未辐照同种异体移植物在前交叉韧带重建（ACLR）中的临床疗效。
方法
按照PRISMA（系统评价和Meta分析的首选报告项目）指南进行系统评价，通过检索PubMed、Cochrane图书馆和Embase，以确定直接比较初次ACLR自体移植物与未辐照同种异体移植物疗效且随访至少2年的比较研究。使用的检索词为：“前交叉韧带”以及自体移植物、同种异体移植物和（辐照或未辐照）。基于移植物失败率、客观国际膝关节文献委员会（IKDC）评分、前后向松弛度以及患者报告结局（主观IKDC评分、视觉模拟量表[VAS]、辛辛那提膝关节评分系统、Lysholm评分和Tegner评分）对患者进行评估。分别使用ROBINS-I和Cochrane协作网的偏倚风险工具对非随机研究和随机研究的偏倚风险进行评估。
结果
16项研究（3项I级、7项II级；6项III级）符合纳入标准，共纳入15502例行ACLR自体移植物手术的患者和1577例行未辐照同种异体移植物手术的患者。平均随访时间为24.0至132.0个月。自体移植物组患者的移植物失败率为0%至9.4%，同种异体移植物组为0%至26.5%。两项研究显示同种异体移植物组中年轻患者的失败率更高。在所纳入的任何研究中，两组之间的客观IKDC评分、前后向松弛度或患者报告结局均无显著差异（P>0.05）。
结论
初次ACLR使用自体移植物和未辐照同种异体移植物的患者报告结局和移植物失败率相似。
证据级别
III级，I-III级研究的系统评价。
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