Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
J Orthop Surg Res. 2024 Nov 29;19(1):809. doi: 10.1186/s13018-024-05310-w.
Hamstring tendon (HT) autografts have become a popular choice for anterior cruciate ligament (ACL) reconstruction. However, small-diameter grafts are inevitably encountered during surgery, which have poor biomechanical properties. Hybrid grafts (HGs) using an allograft combined with small diameter HT are gaining interest from surgeons.
There would be no difference between the HT autograft and HG in terms of failure, knee stability, and patient-reported outcomes.
Systematic review and meta-analysis; Level of evidence, 4.
The PubMed, Embase, web of science and Cochrane databases were systematically searched from their inception until July 1, 2022. Clinical trials that compared HG and HT autografts were included. The quality of the included studies was assessed with the Cochrane Collaboration's risk of bias tool and the modified Newcastle-Ottawa Scale. Extracted data were pooled with fixed or random effects depending on the detected heterogeneity.
A total of 14 eligible studies involving 1411 patients (HT: 863; HG: 548) were included in the quantitative meta-analysis. The mean age of the patients involved ranged from 14.6 to 40.4 years. Compared to patients who received HT autografts, patients receiving HGs had similar postoperative failure rate (OR, 0.99; P = 0.97; I = 41%), side-to-side difference (MD, -0.16; P = 0.13; I = 41%), Subjective IKDC (MD, 0.51; P = 0.58; I = 69%), Lysholm (MD, 2.79; P = 0.1; I = 79%), Tegner (MD, -0.88; P = 0.56; I = 0%). When the available data for failure rate were analyzed by the dose of irradiation, patient age, and mean diameter of the HT, the results of subgroup analyses did not change substantially.
This review found no significant differences in failure rates, knee stability, or patient-reported outcomes between autologous HT and HG in ACLR. Surgeons should prioritize autografts of adequate size through optimized techniques and consider hybrid grafts as a last resort, considering the risks associated with allografts.
跟腱（HT）自体移植物已成为前交叉韧带（ACL）重建的热门选择。然而，手术中不可避免会遇到小直径移植物，其生物力学性能较差。使用同种异体移植物结合小直径 HT 的混合移植物（HG）越来越受到外科医生的关注。
在失败、膝关节稳定性和患者报告的结果方面，HT 自体移植物和 HG 之间没有差异。
系统评价和荟萃分析；证据水平，4 级。
从成立之初到 2022 年 7 月 1 日，系统地检索了 PubMed、Embase、Web of Science 和 Cochrane 数据库。纳入了比较 HG 和 HT 自体移植物的临床试验。使用 Cochrane 协作风险偏倚工具和改良的 Newcastle-Ottawa 量表评估纳入研究的质量。根据检测到的异质性，提取的数据采用固定或随机效应进行汇总。
共有 14 项纳入的研究，涉及 1411 名患者（HT：863；HG：548），纳入了定量荟萃分析。患者的平均年龄范围为 14.6 至 40.4 岁。与接受 HT 自体移植物的患者相比，接受 HG 的患者的术后失败率相似（OR，0.99；P = 0.97；I²=41%），侧到侧差异（MD，-0.16；P = 0.13；I²=41%），主观国际膝关节文献委员会（IKDC）（MD，0.51；P = 0.58；I²=69%），Lysholm（MD，2.79；P = 0.10；I²=79%），Tegner（MD，-0.88；P = 0.56；I²=0%）。当按照射剂量、患者年龄和 HT 平均直径分析失败率的可用数据时，亚组分析的结果并没有实质性变化。
本综述发现 ACLR 中自体 HT 和 HG 在失败率、膝关节稳定性或患者报告的结果方面没有显著差异。外科医生应通过优化技术优先考虑足够大小的自体移植物，并考虑将混合移植物作为最后的手段，同时考虑到同种异体移植物相关的风险。
