Milantoni Vincent, Sritharan Praveen, Abdel Khalik Hassaan, AlKatanani Fares, Juric Matey, de Sa Darren
Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
Curr Rev Musculoskelet Med. 2024 Nov;17(11):496-517. doi: 10.1007/s12178-024-09924-9. Epub 2024 Aug 28.
Graft failure, one of the most common outcomes in anterior cruciate ligament reconstruction randomized controlled trials, lacks a consensus definition. The purpose of this study was to systematically summarize current practice and parameters in defining anterior cruciate ligament reconstruction graft 'failure'.
Forty studies (4466 participants) satisfied the inclusion criteria. Of these, 90% either defined failure formally or referenced the etiology of failure, the remaining 10% used the term failure without referencing the anterior cruciate ligament reconstruction graft. Among the included studies, there was a high level of inconsistency between the definitions of graft failure. The extracted data was categorized into broader groups, revealing abnormal knee laxity (80%) and graft re-rupture (37.5%) as the most common parameters incorporated in the definitions of graft failure in high-level randomized controlled trials. This review shows that anterior cruciate ligament reconstruction randomized controlled trials lack a consistent definition for graft failure. A universal definition is vital for clarity in medical practice and research, ideally incorporating both objective (e.g. graft re-rupture) and subjective (e.g. validated questionnaires) parameters. A composite outcome should be established which includes some of the common parameters highlighted in this review. In the future, this review can be used to assist orthopaedic surgeons to establish a formal definition of anterior cruciate ligament reconstruction graft 'failure'.
移植物失败是前交叉韧带重建随机对照试验中最常见的结果之一，但缺乏共识性定义。本研究的目的是系统总结目前定义前交叉韧带重建移植物“失败”的实践和参数。
40项研究（4466名参与者）符合纳入标准。其中，90%的研究正式定义了失败或提及了失败的病因，其余10%使用了失败一词，但未提及前交叉韧带重建移植物。在纳入的研究中，移植物失败的定义之间存在高度不一致。提取的数据被归类为更广泛的类别，结果显示膝关节松弛异常（80%）和移植物再次断裂（37.5%）是高级别随机对照试验中移植物失败定义中最常纳入的参数。本综述表明，前交叉韧带重建随机对照试验缺乏对移植物失败的一致定义。通用定义对于医学实践和研究的清晰度至关重要，理想情况下应纳入客观（如移植物再次断裂）和主观（如经过验证的问卷）参数。应建立一个综合结果，其中包括本综述中强调的一些常见参数。未来，本综述可用于协助骨科医生建立前交叉韧带重建移植物“失败”的正式定义。
