White Ty, Castro Matthew, Antonio Lucas, Hing Wayne, Tudor Francois, Sattler Larissa
Institute of Health and Sport, Bond University, Gold Coast, Queensland, Australia.
Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
Knee Surg Sports Traumatol Arthrosc. 2025 Jul 18. doi: 10.1002/ksa.12755.
Graft failure following anterior cruciate ligament reconstruction (ACLR) remains a significant challenge, driving discussion for optimal graft choice. Traditionally, hamstring tendon (HT) and bone-patella tendon-bone (BPTB) autografts have been favoured for ACLR. Recently, quadriceps tendon (QT) usage has increased. This systematic review with meta-analysis aims to investigate the available evidence for QT compared to HT and BPTB autografts in terms of graft failure, clinical outcomes, functional outcomes and patient-reported outcome measures (PROMs).
Five databases (PubMed, Cochrane, Embase, SPORTDiscus and CINAHL) were searched to identify randomised controlled trials comparing QT versus HT or BPTB autografts. Outcomes included graft failure, donor site morbidity, complications, reoperations, clinical measures, functional outcomes, and PROMs. Risk of bias was assessed using the Cochrane risk-of-bias tool (RoB2). Meta-analysis using a random effects model was conducted to determine the pooled risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs), and certainty of evidence was evaluated via the GRADE approach.
Twelve RCTs consisting of 636 patients were included. Meta-analysis revealed no differences in graft failure rates (RR = 1.00; 95% CI = 0.97-1.04; p = 0.83; I = 0%; high certainty). QT autografts demonstrated lower donor site morbidity when compared to HT and BPTB autografts (RR = 1.45; 95% CI = 1.24-1.70; p < 0.001; I = 0%; high certainty). No differences were observed in joint laxity or PROM scores at 12 and 24 months, except for Knee injury and Osteoarthritis Outcome Score favouring HT and BPTB at 12 months (RR = 2.49; 95% CI = -4.69 to -0.28; p = 0.03; I = 0%; very low certainty).
QT autografts have similar outcomes for graft failure, laxity and PROMs compared to HT and BPTB; however, QT autografts may have lower donor site morbidity. While each graft type is associated with specific complications and post-operative strength deficits, all three remain viable options for ACLR.
Level I, systematic review of Level I randomised controlled studies.
前交叉韧带重建术（ACLR）后移植物失败仍然是一个重大挑战，引发了关于最佳移植物选择的讨论。传统上，腘绳肌腱（HT）和骨-髌腱-骨（BPTB）自体移植物一直是ACLR的首选。最近，股四头肌肌腱（QT）的使用有所增加。这项荟萃分析的系统评价旨在研究与HT和BPTB自体移植物相比，QT在移植物失败、临床结局、功能结局和患者报告结局指标（PROMs）方面的现有证据。
检索了五个数据库（PubMed、Cochrane、Embase、SPORTDiscus和CINAHL），以识别比较QT与HT或BPTB自体移植物的随机对照试验。结局包括移植物失败、供体部位发病率、并发症、再次手术、临床指标、功能结局和PROMs。使用Cochrane偏倚风险工具（RoB2）评估偏倚风险。采用随机效应模型进行荟萃分析，以确定合并风险比（RR）或平均差（MD）及95%置信区间（CI），并通过GRADE方法评估证据的确定性。
纳入了12项随机对照试验，共636例患者。荟萃分析显示移植物失败率无差异（RR = 1.00；95%CI = 0.97 - 1.04；p = 0.83；I = 0%；高确定性）。与HT和BPTB自体移植物相比，QT自体移植物的供体部位发病率较低（RR = 1.45；95%CI = 1.24 - 1.70；p < 0.001；I = 0%；高确定性）。在12个月和24个月时，关节松弛度或PROM评分无差异，但在12个月时，膝关节损伤和骨关节炎结局评分有利于HT和BPTB（RR = 2.49；95%CI = -4.69至 -0.28；p = 0.03；I = 0%；极低确定性）。
与HT和BPTB相比，QT自体移植物在移植物失败、松弛度和PROMs方面有相似的结局；然而，QT自体移植物的供体部位发病率可能较低。虽然每种移植物类型都与特定的并发症和术后力量缺陷相关，但这三种移植物仍然是ACLR的可行选择。
I级，对I级随机对照研究的系统评价。
