Amit Joshi, Subhash Regmi, Pranodan Poudel, Bibek Basukala
AKB Center for Arthroscopy, Sports Injury, and Regenerative Medicine, Department of Orthopedics, B. & B. Hospital, Gwarko, Lalitpur, Nepal.
Indian J Orthop. 2025 Apr 4;59(4):453-463. doi: 10.1007/s43465-024-01318-w. eCollection 2025 Apr.
The literature lacks enough synthesis on which autograft option is suitable for a particular ligament reconstruction during multi-ligament reconstruction. This study aims to conduct a systematic review of existing literature to determine graft options available for the reconstruction of various ligaments in the context of multi-ligament knee injury.
A systematic review was conducted following the preferred research items for systematic reviews and meta-analyses (PRISMA) guidelines. It was registered in PROSPERO (CRD42024498917). Studies that met the predefined inclusion and exclusion criteria were included in this systematic review.
Out of 8070 identified citations, 16 studies with a total of 640 patients(645 knees), including 420(65.6%) males and 220(34.4%) females, with a mean age of 35.1 years were included. Among 16 papers included in this review, combining autografts, allografts, or synthetic grafts was the preferred choice in seven studies. Autografts were chosen in five research studies, while allografts were preferred in four. For Anterior Cruciate Ligament (ACL) reconstruction: Eleven studies used only autografts, two used only allografts, and 1 study used both autografts and allografts. For Posterior Cruciate Ligament (PCL) reconstruction, nine studies used allografts, six used autografts, and 1 study used synthetic graft. For Posterior Lateral Corner (PLC) reconstruction, six studies used allografts, five used autografts, and 1 study used synthetic graft. For posterior medial corner (PMC) reconstruction, eight studies used autografts, five used allografts, and only one used synthetic grafts.
A combination of autografts, allografts, or synthetic grafts was the preferred graft option for multi-ligament knee reconstruction. Autografts are the most preferred option for ACL and PMC reconstruction, whereas allografts are the most preferred option for PCL and PLC reconstruction. The most preferred autograft was the Hamstring Tendon (HT) autograft. Similarly, the tendoachillies (TA) was the most used allograft. However, the strength of the evidence in this review is moderate to low.
关于在多韧带重建中哪种自体移植选项适用于特定韧带重建，现有文献缺乏足够的综合分析。本研究旨在对现有文献进行系统综述，以确定在多韧带膝关节损伤情况下可用于各种韧带重建的移植选项。
按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行系统综述。该研究已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42024498917）登记。符合预定义纳入和排除标准的研究纳入本系统综述。
在8070条检索到的文献中，纳入了16项研究，共640例患者（645个膝关节），其中男性420例（65.6%），女性220例（34.4%），平均年龄35.1岁。在本综述纳入的16篇论文中，七项研究中联合使用自体移植物、同种异体移植物或合成移植物是首选。五项研究选择了自体移植物，四项研究更倾向于同种异体移植物。对于前交叉韧带（ACL）重建：11项研究仅使用自体移植物，两项仅使用同种异体移植物，一项同时使用自体和同种异体移植物。对于后交叉韧带（PCL）重建，九项研究使用同种异体移植物，六项使用自体移植物，一项使用合成移植物。对于后外侧角（PLC）重建，六项研究使用同种异体移植物，五项使用自体移植物，一项使用合成移植物。对于后内侧角（PMC）重建，八项研究使用自体移植物，五项使用同种异体移植物，仅一项使用合成移植物。
自体移植物、同种异体移植物或合成移植物联合使用是多韧带膝关节重建的首选移植选项。自体移植物是ACL和PMC重建的最优选选项，而异种异体移植物是PCL和PLC重建的最优选选项。最常用的自体移植物是腘绳肌腱（HT）自体移植物。同样，跟腱（TA）是最常用的同种异体移植物。然而，本综述中的证据强度为中到低。
