Trasolini Nicholas A, Lan Rae, Bolia Ioanna K, Hill William, Thompson Ashley A, Mayfield Cory K, Knapik Derrick M, Cole Brian J, Weber Alexander E
USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, California USA.
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.
Orthop J Sports Med. 2023 Jul 13;11(7):23259671231177665. doi: 10.1177/23259671231177665. eCollection 2023 Jul.
Existing systematic reviews have sought to characterize the relative donor-site morbidity of bone-patellar tendon-bone (BTB) and quadriceps tendon (QT) grafts after anterior cruciate ligament reconstruction (ACLR). However, no studies have reported the pooled proportions of patellar fractures and donor tendon ruptures across the body of literature.
To estimate the proportion of patellar fractures, patellar tendon ruptures, and QT ruptures associated with BTB or QT autograft harvest during ACLR using published data.
Systematic review; Level of evidence, 4.
A meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using 3 online databases (PubMed, Scopus, and Web of Science). A total of 800 manuscripts were included in the initial research of peer-reviewed articles in English that reported extensor mechanism complications associated with graft harvest in patients after ACLR. Pooled proportions of patellar fractures, patellar tendon ruptures, and QT ruptures were calculated for each graft type (BTB, QT) using a random-effects model for meta-analysis.
A total of 28 studies were analyzed. The pooled proportion of patellar fractures was 0.57% (95% CI, 0.34%-0.91%) for the BTB harvest and 2.03% (95% CI, 0.78%-3.89%) for the QT harvest. The proportion of patellar tendon ruptures was 0.22% (95% CI, 0.14%-0.33%) after the BTB harvest, and the proportion of QT ruptures was 0.52% (95% CI, 0.06%-1.91%) after the QT harvest. The majority of included studies (16/28 [57.1%]) had an evidence level of 4.
Based on the current literature, the proportion of extensor mechanism complications after ACLR using either a BTB or a QT autograft is low, indicating that the extensor mechanism harvest remains a safe option. A higher proportion of patellar fractures was noted for QT grafts and a higher proportion of donor tendon ruptures was noted for QT grafts compared with BTB grafts.
现有系统评价试图描述前交叉韧带重建（ACLR）后髌腱-骨（BTB）和股四头肌肌腱（QT）移植物相对供区并发症的情况。然而，尚无研究报道整个文献中髌骨骨折和供区肌腱断裂的合并比例。
利用已发表的数据估计ACLR期间采用BTB或QT自体移植物取材时相关的髌骨骨折、髌腱断裂和QT断裂的比例。
系统评价；证据等级，4级。
根据PRISMA（系统评价和Meta分析优先报告条目）指南，使用3个在线数据库（PubMed、Scopus和Web of Science）进行Meta分析。最初检索到800篇英文同行评议文章，这些文章报道了ACLR术后患者移植物取材相关的伸膝装置并发症。采用Meta分析的随机效应模型计算每种移植物类型（BTB、QT）的髌骨骨折、髌腱断裂和QT断裂的合并比例。
共分析了28项研究。BTB取材时髌骨骨折的合并比例为0.57%（95%CI，0.34%-0.91%），QT取材时为2.03%（95%CI，0.78%-3.89%）。BTB取材后髌腱断裂的比例为0.22%（95%CI，0.14%-0.33%），QT取材后QT断裂的比例为0.52%（95%CI，0.06%-1.91%）。纳入的大多数研究（16/28[57.1%]）证据等级为4级。
基于当前文献，ACLR采用BTB或QT自体移植物后伸膝装置并发症的比例较低，表明伸膝装置取材仍是一种安全选择。与BTB移植物相比，QT移植物的髌骨骨折比例更高，供区肌腱断裂比例也更高。
