Vendrig Tom, Keizer Michèle N J, Brouwer Reinoud W, Hoogeslag Roy A G
Center for Human Movement Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Orthopedic Surgery, Martini Hospital, Groningen, Groningen, the Netherlands.
Orthop J Sports Med. 2024 Aug 14;12(8):23259671241258775. doi: 10.1177/23259671241258775. eCollection 2024 Aug.
Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development.
To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR.
Systematic review; Level of evidence, 1.
A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types-hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and allograft-and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR.
Eleven randomized controlled trials were included in the meta-analysis-HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [ > .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up <5 years resulted in similar outcomes for patients with an HT autograft and a BPTB autograft.
This meta-analysis reported no difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR. More research is necessary to make a reliable conclusion about which technique is associated with the lowest incidence of PTOA after ACL surgery.
采用不同移植物类型进行前交叉韧带重建（ACLR）以及前交叉韧带缝合修复（ACLSR）后，移植物的刚度、固定方法和供区发病率的差异可导致膝关节动态松弛度的差异，进而导致创伤后骨关节炎（PTOA）发展的差异。
比较用于初次ACLR的不同移植物类型之间以及初次ACLR与ACLSR之间PTOA的发生率。研究假设为，不同自体移植物和同种异体移植物的ACLR之间以及ACLR与ACLSR之间PTOA的发生率会有所不同。
系统评价；证据等级，1级。
检索文献以确定所有比较不同移植物类型（腘绳肌腱（HT）自体移植物、骨-髌腱-骨（BPTB）自体移植物、股四头肌肌腱自体移植物和同种异体移植物）的ACLR后PTOA的影像学证据，以及ACLR与ACLSR之间的影像学证据的随机对照试验（RCT）。最短随访时间为2年。使用改良的科尔曼方法评分评估研究质量。进行荟萃分析以确定不同移植物类型之间以及ACLR与ACLSR之间PTOA发生率是否存在差异。
荟萃分析纳入了11项随机对照试验——HT：440例患者（平均随访9.7年）；BPTB：307例患者（平均随访11.8年）；同种异体移植物：246例患者（平均随访5年）；ACLSR，22例患者（5年）。未纳入报告股四头肌肌腱ACLR后发生率的研究。研究质量范围为70至88。荟萃分析表明，用于ACLR的移植物类型之间以及ACLR与ACLSR之间PTOA的发生率无显著差异（风险比：HT与BPTB，1.05；HT与同种异体移植物，0.81；BPTB与同种异体移植物，0.82；HT与ACLSR，无法估计[所有均>.05]）。按移植物类型划分的所有研究中PTOA患者的合并数量显示，接受BPTB自体移植物ACLR的患者中PTOA的百分比最高（HT，23.4%；BPTB，29.6%；同种异体移植物，8.1%；ACLSR，0%）。然而，排除随访时间<5年的研究后，HT自体移植物和BPTB自体移植物患者的结果相似。
该荟萃分析报告称，用于ACLR的移植物类型之间以及ACLR与ACLSR之间PTOA的发生率无差异。需要更多研究才能得出关于哪种技术与ACL手术后PTOA最低发生率相关的可靠结论。
