Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Department of Orthopaedics, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Clin Orthop Surg. 2024 Aug;16(4):559-569. doi: 10.4055/cios23396. Epub 2024 Jun 26.
The hamstring autograft can be harvested using various skin incisions, such as vertical, transverse, and oblique incisions, and from different localizations, including anteromedial and posteromedial harvest sites. The aim of this study was to compare studies on the anteromedial and posteromedial approaches for hamstring autograft harvest in terms of clinical outcomes, saphenous nerve injury, infection, operative time, graft length, incision length, range of motion, and patient satisfaction.
Following the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, a search was conducted in PubMed and Scopus, focusing on studies comparing anteromedial and posterior approaches for hamstring harvest. This study was registered with the PROSPERO International Prospective Register of Systematic Reviews (CRD42023450249). Methodological quality was evaluated using the Modified Coleman Methodology Score. Odds ratios (ORs) and mean differences (MDs) quantified dichotomous and continuous outcomes, respectively.
Five articles, involving 405 knees, underwent analysis. Four studies were level 3 evidence, while 1 was level 1. The anteromedial hamstring harvest showed higher rates of saphenous nerve injury (OR, 9.77; 95% confidence interval [CI], 2.19-43.65; = 0.003) and longer operative times, with an MD of about 13 minutes (MD, 13.33; 95% CI, 0.68-25.97; = 0.04), compared to the posteromedial approach. The anteromedial method yielded a longer semitendinosus graft, with an MD of about 17 mm (MD, 17.57; 95% CI, 7.17-27.98; = 0.0009). However, no significant differences existed in range of motion, flexion contracture, unintentional graft harvest, infection rates, and patient-reported outcomes. Notably, the posteromedial group reported higher cosmetic satisfaction, with 92% being very satisfied, compared to the anteromedial group with 80% ( = 0.005). However, overall satisfaction levels were similar between the 2 groups ( = 0.35), with a very satisfied rate of 72% for the anteromedial group and 78% for the posteromedial group.
The anteromedial hamstring harvest showed greater saphenous nerve injury and longer operative times compared to the posteromedial approach, along with a longer graft. However, no significant differences were observed in the range of motion, flexion contracture, graft harvest, infection, or patient outcomes.
腘绳肌腱可以通过各种皮肤切口（如垂直、横切和斜切口）和不同的部位（包括前内侧和后内侧采集部位）进行采集。本研究旨在比较腘绳肌腱前内侧和后内侧采集方法的临床结果、隐神经损伤、感染、手术时间、移植物长度、切口长度、活动范围和患者满意度。
根据 2020 年系统评价和荟萃分析的首选报告项目（PRISMA）指南，在 PubMed 和 Scopus 中进行了检索，重点比较了前内侧和后内侧入路采集腘绳肌腱的研究。该研究已在 PROSPERO 国际系统评价注册中心（CRD42023450249）进行了注册。使用改良 Coleman 方法学评分评估方法学质量。比值比（OR）和均数差值（MD）分别量化了二分类和连续结局。
有 5 篇文章，涉及 405 个膝关节，进行了分析。4 项研究为 3 级证据，1 项为 1 级证据。与后内侧入路相比，前内侧腘绳肌腱采集法的隐神经损伤发生率更高（OR，9.77；95%置信区间 [CI]，2.19-43.65； = 0.003），手术时间更长，平均约 13 分钟（MD，13.33；95%CI，0.68-25.97； = 0.04）。前内侧方法产生的半腱肌移植物较长，平均约 17 毫米（MD，17.57；95%CI，7.17-27.98； = 0.0009）。然而，在活动范围、屈曲挛缩、非故意移植物采集、感染率和患者报告的结果方面，两组间无显著差异。值得注意的是，后内侧组报告的美容满意度较高，92%的患者非常满意，而前内侧组为 80%（ = 0.005）。然而，两组的总体满意度相似（ = 0.35），前内侧组非常满意的比例为 72%，后内侧组为 78%。
与后内侧入路相比，前内侧腘绳肌腱采集法的隐神经损伤和手术时间更长，移植物也更长。然而，在活动范围、屈曲挛缩、移植物采集、感染或患者结局方面，两组间无显著差异。
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