Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, 1200 Main St West, Hamilton, ON, 4E14L8N 3Z5, Canada.
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4437-4447. doi: 10.1007/s00167-023-07515-8. Epub 2023 Jul 21.
To compare graft dimensions, functional outcomes, and failure rates following anterior cruciate ligament reconstruction (ACLR) with either five-strand or four-strand hamstring autograft options.
Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 22 April 2023 for level I and II studies comparing five- and four-strand hamstring autografts in ACLR. The authors adhered to the PRISMA and R-AMSTAR guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, surgical details and rehabilitation, graft diameter, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot shift test, and graft rupture were extracted. PROMs included Knee Osteoarthritis and Outcome Score (KOOS) subscales, Lysholm, and International Knee Documentation Committee (IKDC).
One randomized controlled trial (RCT) and four prospective cohort studies with 572 patients were included. Graft diameters were larger in the five-strand group with a mean difference of 0.93 mm (95% CI 0.61 to 1.25, p < 0.001, I = 66%). The five-strand group reported statistically higher KOOS ADL subscale and Lysholm scores with a mean difference of 4.85 (95% CI 0.14 to 9.56, p = 0.04, I = 19%) and 3.01 (95% CI 0.48 to 5.53, p = 0.02, I = 0%), respectively. There were no differences in KOOS symptoms, pain, quality of life, or sports subscales, or IKDC scores. There were no differences in rates of positive Lachman test, positive pivot shift test, or graft rupture with pooled odds ratios of 0.62 (95% CI 0.13 to 2.91, n.s., I = 80%), 0.94 (95% CI 0.51 to 1.75, n.s., I = 31%), and 2.13 (95% CI 0.38 to 12.06, n.s., I = 0%), respectively.
Although five-stranded hamstring autografts had significantly larger graft diameters compared to four-stranded grafts with a mean difference of 0.93 mm, similar graft rupture rates and clinical laxity assessments were identified following ACLR. While some PROMs were statistically superior in the five-stranded hamstring groups, the threshold for the minimal clinical important difference was not reached indicating similar clinical outcomes overall.
Level II.
比较前交叉韧带重建（ACLR）中使用五股和四股腘绳肌腱自体移植物的移植物尺寸、功能结果和失败率。
从创建到 2023 年 4 月 22 日，三个数据库（MEDLINE、PubMed 和 EMBASE）对比较 ACLR 中五股和四股腘绳肌腱自体移植物的 I 级和 II 级研究进行了搜索。作者遵循 PRISMA 和 R-AMSTAR 指南以及 Cochrane 干预系统评价手册。提取了人口统计学、手术细节和康复、移植物直径、患者报告的结果测量（PROMs）以及 Lachman 试验阳性、髌股关节旋转试验阳性和移植物破裂的阳性率数据。PROMs 包括膝关节骨关节炎和结果评分（KOOS）亚量表、Lysholm 和国际膝关节文献委员会（IKDC）。
纳入了一项随机对照试验（RCT）和四项前瞻性队列研究，共 572 名患者。五股组的移植物直径较大，平均差异为 0.93mm（95%CI 0.61 至 1.25，p<0.001，I=66%）。五股组报告的 KOOS ADL 亚量表和 Lysholm 评分统计上更高，平均差异分别为 4.85（95%CI 0.14 至 9.56，p=0.04，I=19%）和 3.01（95%CI 0.48 至 5.53，p=0.02，I=0%）。KOOS 症状、疼痛、生活质量或运动亚量表或 IKDC 评分无差异。Lachman 试验阳性、髌股关节旋转试验阳性或移植物破裂的阳性率无差异，合并比值比分别为 0.62（95%CI 0.13 至 2.91，无统计学意义，I=80%）、0.94（95%CI 0.51 至 1.75，无统计学意义，I=31%）和 2.13（95%CI 0.38 至 12.06，无统计学意义，I=0%）。
尽管五股腘绳肌腱自体移植物的移植物直径明显大于四股移植物，平均差异为 0.93mm，但 ACLR 后发现移植物破裂率和临床松弛度评估相似。虽然五股腘绳肌腱组的一些 PROMs 在统计学上更优，但最小临床重要差异的阈值未达到，表明总体临床结果相似。
II 级。
