Kurkowski Sarah C, Thimmesch Michael J, Murphy Meredith, Kuechly Henry A, Emmert Andrew S, Grawe Brian
Department of Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
Medical College of Wisconsin Medical School, Milwaukee, Wisconsin, USA.
Am J Sports Med. 2025 Jan 7:3635465241266628. doi: 10.1177/03635465241266628.
The use of quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction has been increasing since 2014. Studies have shown that QT is comparable to hamstring tendon (HT) and bone-patellar tendon-bone (BTB) autografts in terms of outcomes, although QT autograft has lower rates of donor site morbidity. Systematic reviews and meta-analyses have been previously conducted on this topic, although none have focused solely on data of patients at least 5 years out from surgery.
HYPOTHESIS/PURPOSE: The purpose of this meta-analysis was to demonstrate that QT may not be superior to BTB and HT autografts and that long-term studies must be performed before recommending QT over other graft choices. It was hypothesized that there would be less available data at ≥5 years of follow-up for patients with QT than those with HT and BTB autografts, and that patient-reported outcomes would be similar between all 3 graft choices.
Meta-analysis; Level of evidence, 4.
The PubMed/MEDLINE, Scopus (Elsevier), Embase, and Cochrane Library databases were queried for studies that reported on QT, BTB, or HT outcomes at ≥5 years after ACL reconstruction (ACLR). In total, 27 studies were included; patient and outcome data were collected from each. Summary odds ratios were calculated for each outcome and compared between all graft types.
The sheer volume of available patient data on QT autografts at ≥5 years after ACLR is vastly different from what is available on HT and BTB autografts (which have almost 3 times the amount of patient data as compared with QT). HT had the highest failure rate (12.7%), followed by QT (9.1%) and BTB (6.4%); summary odds ratios favored BTB over both QT and HT in terms of failure rate. Patient-reported outcomes were comparable between graft types, although some comparisons were not adequately powered.
This meta-analysis reveals critical information on the current state of the literature surrounding QT use in ACLR. Most notably, additional mid-term and long-term patient data are needed on those undergoing ACLR with QT autograft. There is not enough long-term outcome data on QT to recommend it over HT or BTB for primary ACLR.
自2014年以来，股四头肌肌腱（QT）自体移植物用于前交叉韧带（ACL）重建的情况一直在增加。研究表明，尽管QT自体移植物供区并发症发生率较低，但在疗效方面，QT与腘绳肌腱（HT）和骨-髌腱-骨（BTB）自体移植物相当。此前已针对该主题进行了系统评价和荟萃分析，尽管没有一项仅关注术后至少5年患者的数据。
假设/目的：本荟萃分析的目的是证明QT可能并不优于BTB和HT自体移植物，并且在推荐QT优于其他移植物选择之前必须进行长期研究。假设是，与HT和BTB自体移植物的患者相比，接受QT的患者在随访≥5年时可获得的数据较少，并且所有三种移植物选择的患者报告结局相似。
荟萃分析；证据等级，4级。
在PubMed/MEDLINE、Scopus（爱思唯尔）、Embase和Cochrane图书馆数据库中查询报告ACL重建（ACLR）术后≥5年QT、BTB或HT结局的研究。总共纳入27项研究；从每项研究中收集患者和结局数据。计算每个结局的汇总比值比，并在所有移植物类型之间进行比较。
ACLR术后≥5年时，关于QT自体移植物的可用患者数据量与HT和BTB自体移植物的可用数据量有很大差异（HT和BTB的患者数据量几乎是QT的3倍）。HT的失败率最高（12.7%），其次是QT（9.1%）和BTB（6.4%）；在失败率方面，汇总比值比显示BTB优于QT和HT。尽管有些比较的效力不足，但不同移植物类型的患者报告结局具有可比性。
本荟萃分析揭示了有关ACLR中使用QT的当前文献状态的关键信息。最值得注意的是，需要更多关于接受QT自体移植物进行ACLR患者的中期和长期患者数据。关于QT的长期结局数据不足，无法推荐其在原发性ACLR中优于HT或BTB。
