Khalefa Mohamed A, Aujla Randeep S, Aslam Nadim, Boutefnouchet Tarek, D'Alessandro Peter, MacDonald Peter B, Malik Shahbaz S
Worcestershire Acute Hospitals NHS Trust, Sky Level 3, Charles Hastings Way, Worcester WR5 1DD, United Kingdom; Cairo University Hospitals, Cairo, Egypt.
University Hospitals of Leicester, Leicester, United Kingdom.
Orthop Traumatol Surg Res. 2025 Apr;111(2):103926. doi: 10.1016/j.otsr.2024.103926. Epub 2024 Jul 17.
The autograft of choice for anterior cruciate ligament reconstruction (ACLR) remains debateable. Recently there has been increased popularity of soft tissue quadriceps tendon (s-QT) autograft due to less donor site morbidity, reduced anterior knee pain and comparable re-operation and complication rates. The aim of this review was to analyse functional outcomes of primary ACLR using s-QT in adult population without the bone plug and to report its complication profile against other autografts.
This systematic review was performed in accordance with PRISMA guidelines and a review of literature was conducted on four online databases (Medline, EMBASE, Cochrane and Google Scholar). Clinical studies reporting on patients undergoing primary ACLR with s-QT autograft or in comparison to BPTB or HS autografts with a minimum of 6 months follow-up were included. The studies were inclusive of only all soft tissue QT autograft regardless of the implants or fixation method used. Critical appraisal of studies was conducted using the Methodological Index for Non-Randomized Studies (MINORS) tool.
Fourteen studies were eligible. There were three randomised control studies (RCT) and 11 non-randomised comparative studies with 1543 patients who underwent ACLR. 682 underwent s-QT, 498 had hamstring tendon (HT) and 174 had bone-patellar tendon-bone (BPTB). 60% (n = 930) were males and mean follow up was 23.6 months (6-65). Eight studies reported post-operative patient reported outcome measures (PROMs). The mean International Knee Documentation Committee (IKDC) score was 91.5 ± 15.1 whereas mean Lysholm score was 90 ± 3.9. Five studies reported on laxity with mean anterior tibial translation (ATT) of 1.28 ± 1.09 mm. Overall complication rate of s-QT ACLR was 6% with 3% graft failure, 0.52% arthrofibrosis, 0.2% infection, 0.75% revision ACLR. There was no significant difference in functional outcome scores, knee stability and range of motion (ROM) between s-QT, HT and BPTB.
s-QT for ACLR has a comparable functional outcome, laxity, failure and with overall graft failure rate of 3%.
III; Systematic review and meta-analysis.
前交叉韧带重建术（ACLR）的自体移植物选择仍存在争议。近年来，由于供区并发症较少、膝前疼痛减轻以及再次手术率和并发症发生率相当，软组织股四头肌肌腱（s-QT）自体移植物越来越受欢迎。本综述的目的是分析在无骨栓的成年人群中使用s-QT进行初次ACLR的功能结果，并报告其与其他自体移植物相比的并发症情况。
本系统综述按照PRISMA指南进行，并在四个在线数据库（Medline、EMBASE、Cochrane和谷歌学术）上进行文献检索。纳入报告初次接受s-QT自体移植物ACLR的患者或与骨-髌腱-骨（BPTB）或腘绳肌腱（HT）自体移植物相比且至少随访6个月的临床研究。这些研究仅包括所有软组织QT自体移植物，无论使用何种植入物或固定方法。使用非随机研究方法学指数（MINORS）工具对研究进行严格评价。
14项研究符合条件。有3项随机对照研究（RCT）和11项非随机对照研究，共1543例接受ACLR的患者。682例接受s-QT，498例接受腘绳肌腱（HT），174例接受骨-髌腱-骨（BPTB）。60%（n = 930）为男性，平均随访时间为23.6个月（6 - 65个月）。8项研究报告了术后患者报告结局测量（PROMs）。国际膝关节文献委员会（IKDC）平均评分为91.5 ± 15.1，而Lysholm平均评分为90 ± 3.9。5项研究报告了膝关节松弛情况，平均胫骨前移（ATT）为1.28 ± 1.09 mm。s-QT ACLR的总体并发症发生率为6%，其中移植物失败率为3%，关节纤维化率为0.52%，感染率为0.2%，再次ACLR率为0.75%。s-QT、HT和BPTB在功能结局评分、膝关节稳定性和活动范围（ROM）方面无显著差异。
用于ACLR的s-QT具有相当的功能结局、膝关节松弛度和失败率，总体移植物失败率为3%。
III级；系统综述和荟萃分析。
