Soeder Jack S, Yavari Ehsan, Lameire Darius L, Lemieux Valerie, Abouali Jihad
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Orthop J Sports Med. 2025 Mar 11;13(3):23259671241310808. doi: 10.1177/23259671241310808. eCollection 2025 Mar.
Contralateral donor autografts in anterior cruciate ligament (ACL) reconstruction (ACLR) may act as an alternative to conventional ipsilateral donor grafts but are rarely used clinically because of the lack of evidence on patient outcomes and concerns around additional morbidity.
To investigate the effect of contralateral versus ipsilateral autograft use in ACLR on patient outcomes.
Systematic review; Level of evidence, 4.
The MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases were searched from inception to October 2022 for comparative studies assessing the clinical or functional outcomes of ipsilateral versus contralateral autograft harvest in primary or revision ACLR. Given the heterogeneity of the included studies, data were summarized using descriptive statistics.
Included were 11 studies representing 1638 patients with a mean follow-up of 49 months. The mean time to return to sport was shorter in patients treated with a contralateral bone-patellar tendon-bone (BPTB) autograft in 2 of 3 studies that evaluated this outcome after primary ACLR and in the only study that evaluated this outcome after revision ACLR. Some studies found improved strength recovery in the contralateral ACL-reconstructed knee. Otherwise, there was no significant difference between contralateral and ipsilateral ACLRs on subjective or objective postoperative clinical outcome scores. Most studies reported minimal donor site morbidity. Clinical adverse events including postoperative graft rerupture and infection were low in both contralateral and ipsilateral ACLRs and were not significantly different.
Contralateral ACL autograft harvest may lead to earlier return to sport when patients undergo BPTB ACLR. However, clinical outcomes, morbidity, risk of rerupture, and risk of donor knee injury were not significantly different in this review.
前交叉韧带（ACL）重建（ACLR）中使用对侧自体移植物可作为传统同侧自体移植物的替代方法，但由于缺乏关于患者预后的证据以及对额外发病率的担忧，临床上很少使用。
探讨ACLR中使用对侧与同侧自体移植物对患者预后的影响。
系统评价；证据等级，4级。
检索MEDLINE、Embase和Cochrane对照试验中央注册库数据库，从建库至2022年10月，查找评估初次或翻修ACLR中同侧与对侧自体移植物取材的临床或功能预后的比较研究。鉴于纳入研究的异质性，使用描述性统计对数据进行总结。
纳入11项研究，共1638例患者，平均随访49个月。在3项评估初次ACLR后该结局的研究中的2项以及唯一一项评估翻修ACLR后该结局的研究中，接受对侧骨-髌腱-骨（BPTB）自体移植物治疗的患者恢复运动平均时间更短一些。一些研究发现对侧ACL重建膝关节的力量恢复有所改善。除此之外，对侧与同侧ACLR在主观或客观术后临床结局评分方面无显著差异。大多数研究报告供区发病率极低。对侧和同侧ACLR术后包括移植物再断裂和感染在内的临床不良事件发生率均较低，且无显著差异。
当患者接受BPTB ACLR时，对侧ACL自体移植物取材可能使患者更早恢复运动。然而，在本综述中，临床结局、发病率、再断裂风险和供体膝关节损伤风险并无显著差异。
