Department of Orthopedic Surgery, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan.
Institute for Medical Regulatory Science, Comprehensive Research Organization, Waseda University, Shinjuku, Tokyo, Japan.
Am J Sports Med. 2024 Feb;52(2):535-543. doi: 10.1177/03635465221150654. Epub 2023 Mar 6.
Because grafts are made in 0.5-mm increments clinically for anterior cruciate ligament (ACL) reconstruction, it is important to clarify how the failure rate decreases as the diameter increases. Moreover, it is important to know whether even a slight increase in the graft diameter decreases the risk of failure.
The risk of failure decreases significantly with each 0.5-mm increase in hamstring graft diameter.
Meta-analysis; Level of evidence, 4.
The systematic review and meta-analysis have estimated the diameter-specific failure risk for each 0.5-mm increase in ACL reconstruction using autologous hamstring grafts. We searched for studies describing the relationship between graft diameter and failure rate published before December 1, 2021, in leading databases, such as PubMed, EMBASE, Cochrane Library, and Web of Science, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies using single-bundle autologous hamstring grafts to investigate the relationship between failure rate and graft diameter of 0.5-mm intervals with >1-year follow-up. Then, we calculated the failure risk caused by 0.5-mm differences in autologous hamstring graft diameter. Assuming Poisson distribution for the statistical model, we employed an extended linear mixed-effects model in the meta-analyses.
Five studies containing 19,333 cases were eligible. The meta-analysis revealed that the estimated value of the coefficient of diameter in the Poisson model was -0.2357 with a 95% CI of -0.2743 to -0.1971 ( < .0001). With every 1.0-mm increase in diameter, the failure rate decreased by 0.79 (0.76-0.82) times. In contrast, the failure rate increased by 1.27 (1.22-1.32) times for each 1.0-mm decrease in diameter. The failure rate significantly decreased with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm from 3.63% to 1.79%.
The risk of failure decreased correspondingly with each 0.5-mm increase in graft diameter in the range of <7.0 to >9.0 mm. Failure is multifactorial; however, increasing the graft diameter as much as possible to match each patient's anatomic space without overstuffing is an effective precaution that surgeons can take to reduce failures.
由于临床上在前交叉韧带（ACL）重建中以 0.5 毫米的增量制作移植物，因此明确直径增加时失败率如何降低非常重要。此外，了解移植物直径即使略有增加是否也会降低失败的风险很重要。
随着跟腱移植物直径每增加 0.5 毫米，失败的风险显著降低。
荟萃分析；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，我们系统地回顾和荟萃分析了使用自体跟腱移植物进行 ACL 重建时，每增加 0.5 毫米直径与失败风险之间的关系。我们在主要数据库（如 PubMed、EMBASE、Cochrane 图书馆和 Web of Science）中搜索了截至 2021 年 12 月 1 日之前描述移植物直径与失败率之间关系的研究，这些研究发表在这些数据库中。我们纳入了使用单束自体跟腱移植物的研究，以调查 0.5 毫米间隔的移植物直径与 >1 年随访之间的失败率关系。然后，我们计算了由自体跟腱移植物直径的 0.5 毫米差异引起的失败风险。对于统计模型，我们假设泊松分布，并在荟萃分析中使用扩展的线性混合效应模型。
有 5 项研究共纳入 19333 例患者符合条件。荟萃分析显示，泊松模型中直径系数的估计值为-0.2357，95%CI 为-0.2743 至-0.1971（<0.0001）。直径每增加 1.0 毫米，失败率降低 0.79（0.76-0.82）倍。相比之下，直径每减少 1.0 毫米，失败率增加 1.27（1.22-1.32）倍。在 7.0 至>9.0 毫米的范围内，移植物直径每增加 0.5 毫米，失败率从 3.63%降至 1.79%，显著降低。
在 7.0 至>9.0 毫米的范围内，移植物直径每增加 0.5 毫米，失败的风险相应降低。失败是多因素的；然而，尽可能地增加移植物直径以匹配每个患者的解剖空间而不出现过度填充，是外科医生可以采取的有效预防措施，以降低失败率。
