Vivekanantha Prushoth, Nedaie Soroush, Hassan Zackariyah, Abdel Khalik Hassaan, Carsen Sasha, Nagai Kanto, Hoshino Yuichi, de Sa Darren
Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Center, 1200 Main St West, Hamilton, ON, L8S 4L8, Canada.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):5641-5651. doi: 10.1007/s00167-023-07597-4. Epub 2023 Oct 21.
To evaluate the clinical outcomes of primary or revision ACL reconstruction (ACLR) after contralateral hamstring autografts versus ipsilateral hamstring autograft harvest.
Three databases (MEDLINE, PubMed and EMBASE) were searched from inception to April 27th, 2023 for studies investigating contralateral hamstring autografts in primary or revision 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, strength measures, patient-reported outcome measures (PROMs), and rates of positive Lachman test, positive pivot-shift test and graft rupture were extracted. PROMs included Lysholm, International Knee Documentation Committee (IKDC) and Tegner scores.
Nine studies comprising 371 patients were included in this review. In primary ACLR, there were no significant differences between contralateral and ipsilateral groups in isokinetic hamstring torque in the non-ACLR limb or isokinetic quadriceps torque in both limbs when tested at 60, 90, 120 or 180 degrees/second. Isokinetic hamstring torque in the non-ACLR limb was significantly weaker in the contralateral group at six months for primary ACLR; however, these deficits did not persist. There were no significant differences in postoperative median Tegner scores and Lysholm scores between contralateral and ipsilateral groups in primary ACLR. There were no significant differences in postoperative median Tegner, mean Lysholm and IKDC scores between groups in revision ACLR. There were no significant differences in positive Lachman, positive pivot-shift and rupture rates in primary ACLR between groups. Rates of positive Lachman and pivot-shift were slightly higher in the contralateral than ipsilateral group for revision ACLR.
Contralateral hamstring autografts results in comparable muscle strength to ipsilateral hamstring autografts, with the exception of weaker hamstring strengths in the early postoperative period. Patient-reported outcome measures were similar between the two groups across both primary and revision ACLR, with rates of instability and failure being similar between groups for primary ACLR. Contralateral hamstring grafts do not provide additional benefit when compared to ipsilateral options for either primary or revision ACLR, and should be used only in select circumstances including insufficient ipsilateral hamstring grafts or situations where quadriceps or patella autografts are not optimal.
Level IV.
评估在初次或翻修前交叉韧带重建术（ACLR）中，取自对侧腘绳肌自体移植物与取自同侧腘绳肌自体移植物的临床疗效。
检索了三个数据库（MEDLINE、PubMed和EMBASE），从建库至2023年4月27日，查找有关初次或翻修ACLR中对侧腘绳肌自体移植物的研究。作者遵循PRISMA和R-AMSTAR指南以及《Cochrane干预措施系统评价手册》。提取了人口统计学数据、力量测量数据、患者报告的结局测量指标（PROMs）以及Lachman试验阳性率、轴移试验阳性率和移植物破裂率。PROMs包括Lysholm评分、国际膝关节文献委员会（IKDC）评分和Tegner评分。
本综述纳入了9项研究，共371例患者。在初次ACLR中，当以60、90、120或180度/秒的速度进行测试时，对侧组和同侧组在非ACLR肢体的等速腘绳肌扭矩或双下肢的等速股四头肌扭矩方面无显著差异。对于初次ACLR，对侧组在术后6个月时非ACLR肢体的等速腘绳肌扭矩明显较弱；然而，这些差异并未持续存在。在初次ACLR中，对侧组和同侧组术后的中位Tegner评分和Lysholm评分无显著差异。在翻修ACLR中，各组术后的中位Tegner评分、平均Lysholm评分和IKDC评分无显著差异。在初次ACLR中，各组之间的Lachman试验阳性率、轴移试验阳性率和破裂率无显著差异。在翻修ACLR中，对侧组的Lachman试验阳性率和轴移试验阳性率略高于同侧组。
除术后早期腘绳肌力量较弱外，对侧腘绳肌自体移植物产生的肌肉力量与同侧腘绳肌自体移植物相当。在初次和翻修ACLR中，两组患者报告的结局测量指标相似，初次ACLR中两组之间的不稳定率和失败率相似。与同侧选择相比，对侧腘绳肌移植物在初次或翻修ACLR中均未提供额外益处，仅应在特定情况下使用，包括同侧腘绳肌移植物不足或股四头肌或髌骨自体移植物不理想的情况。
四级。
