Mercurio Michele, Cofano Erminia, Cosentino Orlando, Corona Katia, Mocini Fabrizio, Rossi Umberto, Galasso Olimpio, Gasparini Giorgio, Cerciello Simone
Department of Orthopaedic and Trauma Surgery "Magna Graecia" University, "Mater Domini" University Hospital Catanzaro Italy.
Research Center on Musculoskeletal Health, MusculoSkeletal Health@UMG Magna Graecia University Catanzaro Italy.
J Exp Orthop. 2025 Jul 18;12(3):e70326. doi: 10.1002/jeo2.70326. eCollection 2025 Jul.
Anterior cruciate ligament reconstruction (ACLR) yields favourable results, but failure and reinjury rates are still a concern. Graft choice is a modifiable risk factor for surgeons to avoid failure. The topic of optimal graft selection remains a subject of ongoing debate. Graft choices include autografts, allografts and synthetic grafts. The purpose of this meta-analysis was to compare functional outcomes and complications between autografts, hamstring (HT) tendon and bone-patellar-tendon-bone, and synthetic graft in primary ACLR.
The PubMed, MEDLINE, Scopus and Cochrane Central databases were used for the research, and nine studies were included. The first author, journal name, year of publication, patient demographics, type of surgery, type of graft used for ACLR, time from injury to surgery, and follow-up period were recorded. The data extracted for quantitative analysis included Lysholm activity scale score, Tegner activity scale score, International Knee Documentation Committee (IKDC) score, laxity measured with the KT-1000 knee arthrometer (KT-1000), number of complications, re-rupture, and re-intervention rates. Random and fixed effect models were used for the meta-analysis of pooled mean differences (MDs) and odds ratios (ORs).
A total of 734 patients were identified, 377 of whom underwent ACLR with autograft and 326 with synthetic graft. The mean age was 28.7 ± 20.3 and 31.6 ± 9.3 years for the ACLR with autograft and ACLR with synthetic graft groups. The mean follow-up durations were 82.3 ± 38 and 81.4 ± 39.2 months. Comparable postoperative Lysholm knee score ( = 0.06), Tegner activity scale score ( = 0.64) and IKDC score ( = 0.15) were found between groups. Significantly greater knee laxity was found in the autograft group (2.6 ± 1.4 and 1.5 ± 1.4 mm; MD = 1.22, 95% confidence interval [CI]: 0.96, 1.48; < 0.001). Comparable overall complications ( = 0.70), re-rupture ( = 0.81) and re-intervention ( = 0.85) rates were found between groups.
Compared to ACLR with HT autograft, the ACLR with synthetic graft showed statistically but not clinically important decreased knee laxity. Comparable functional outcomes, complication and re-rupture rates were found between the two groups.
Level I, meta-analysis.
前交叉韧带重建术（ACLR）效果良好，但失败率和再次损伤率仍是问题所在。移植物选择是外科医生可调节的风险因素，以避免手术失败。最佳移植物选择这一话题仍是持续争论的焦点。移植物选择包括自体移植物、同种异体移植物和合成移植物。本荟萃分析的目的是比较初次ACLR中自体移植物、腘绳肌腱（HT）和骨-髌腱-骨以及合成移植物之间的功能结局和并发症情况。
使用PubMed、MEDLINE、Scopus和Cochrane Central数据库进行研究，纳入9项研究。记录第一作者、期刊名称、发表年份、患者人口统计学资料、手术类型、ACLR所用移植物类型、受伤至手术时间以及随访期。提取用于定量分析的数据包括Lysholm活动量表评分、Tegner活动量表评分、国际膝关节文献委员会（IKDC）评分、使用KT-1000膝关节测角仪（KT-1000）测量的松弛度、并发症数量、再次断裂和再次干预率。采用随机和固定效应模型对合并均数差（MDs）和比值比（ORs）进行荟萃分析。
共纳入734例患者，其中377例行自体移植物ACLR，326例行合成移植物ACLR。自体移植物ACLR组和合成移植物ACLR组的平均年龄分别为28.7±20.3岁和31.6±9.3岁。平均随访时间分别为82.3±38个月和81.4±39.2个月。两组术后Lysholm膝关节评分（=0.06）、Tegner活动量表评分（=0.64）和IKDC评分（=0.15）相当。自体移植物组膝关节松弛度显著更大（2.6±1.4和1.5±1.4mm；MD=1.22，95%置信区间[CI]：0.96，1.48；<0.001）。两组总体并发症（=0.70）、再次断裂（=0.81）和再次干预（=0.85）率相当。
与自体HT移植物ACLR相比，合成移植物ACLR在统计学上显示膝关节松弛度降低，但在临床上无显著差异。两组在功能结局、并发症和再次断裂率方面相当。
I级，荟萃分析。
