Opoku Michael, Abdramane Abakar Mahamat, Abdirahman Ahmed, Fang Mingqing, Li Yusheng, Xiao Wenfeng
Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, China.
Xiangya School of Medicine, Central South University, Changsha, Hunan, 410083, China.
J Orthop Surg Res. 2025 Jul 29;20(1):719. doi: 10.1186/s13018-025-06080-9.
To perform a meta-analysis to compare and critically evaluate the short and medium-term clinical outcomes of peroneus longus tendon autograft and hamstring tendon autograft in anterior cruciate ligament (ACL) reconstruction. The study further evaluates the viability of the PLT autograft as a non-inferior alternative to the conventional HT autograft.
We independently searched the following electronic databases: PubMed, Cochrane Library, Embase, and Web of Science for all relevant articles from inception to March 2025, in only the English language. Clinical outcomes included: IKDC score, Lysholm score, Tegner score, Tegner-Lysholm score, Visual-Analog-Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, Modified Cincinnati score, graft diameter, thigh circumference, graft harvest time, Knee laxity & stability (Lachman test, Pivot Shift test, and Anterior Drawer test), and Donor-site morbidity. Funnel plots were used to detect publication bias. All statistical analysis was performed using R (version 4.1.3).
A total of 25 studies, 9 RCTs, and 16 cohort studies containing 1944 patients were included in this analysis. No statistically significant differences were observed between PLT and HT autografts in functional outcomes, including Tegner scores, Lysholm scores, Tegner-Lysholm scores, VAS scores, or objective measures of knee stability and laxity across all follow-up periods. Notably, the PLT group demonstrated superior outcomes compared to the HT group, including significantly larger graft diameter, reduced graft harvesting time, improved Modified Cincinnati Scores at both 12- and 24-month follow-ups, and lower donor-site morbidity rates. Despite significantly higher IKDC scores in the PLT group at 6 months postoperatively, no significant differences were observed at 12-, and 18, 24, or 36-month follow-up. Conversely, PLT groups had slightly lower AOFAS scores at 12 or 24 months follow-up than the HT group.
The PLT autograft demonstrates comparable clinical outcomes to HT autograft in ACL reconstruction while offering distinct advantages, including significantly larger graft diameter, reduced harvest time, and lower donor-site morbidity. These benefits, coupled with equivalent postoperative functional results, position the PLT autograft as a promising alternative to traditional HT autograft. Long-term follow-up and higher-quality studies are needed to support our results and further investigate the differences between PLT autograft and HT autograft.
Level III.
进行一项荟萃分析，以比较和批判性评估在重建前交叉韧带（ACL）时，自体腓骨长肌腱移植与自体腘绳肌腱移植的短期和中期临床结果。该研究进一步评估了自体腓骨长肌腱移植作为传统自体腘绳肌腱移植的非劣效替代方案的可行性。
我们独立检索了以下电子数据库：PubMed、Cochrane图书馆、Embase和Web of Science，以查找从数据库建立至2025年3月的所有相关英文文章。临床结果包括：国际膝关节文献委员会（IKDC）评分、Lysholm评分、Tegner评分、Tegner-Lysholm评分、视觉模拟量表（VAS）评分、美国足踝外科协会（AOFAS）评分、改良辛辛那提评分、移植物直径、大腿围度、移植物获取时间、膝关节松弛度和稳定性（Lachman试验、轴移试验和前抽屉试验）以及供区并发症。采用漏斗图检测发表偏倚。所有统计分析均使用R（版本4.1.3）进行。
本分析共纳入25项研究，其中9项随机对照试验（RCT）和16项队列研究，包含1944例患者。在所有随访期内，自体腓骨长肌腱移植和自体腘绳肌腱移植在功能结果方面，包括Tegner评分、Lysholm评分、Tegner-Lysholm评分、VAS评分，或膝关节稳定性和松弛度的客观测量上，均未观察到统计学上的显著差异。值得注意的是，与自体腘绳肌腱移植组相比，自体腓骨长肌腱移植组表现出更优的结果，包括移植物直径显著更大、移植物获取时间缩短、在12个月和24个月随访时改良辛辛那提评分改善，以及供区并发症发生率更低。尽管自体腓骨长肌腱移植组在术后6个月时IKDC评分显著更高，但在12个月、18个月、24个月或36个月随访时未观察到显著差异。相反，自体腓骨长肌腱移植组在12个月或24个月随访时的AOFAS评分略低于自体腘绳肌腱移植组。
在ACL重建中，自体腓骨长肌腱移植与自体腘绳肌腱移植的临床结果相当，同时具有明显优势，包括移植物直径显著更大、获取时间缩短和供区并发症更低。这些益处，再加上术后功能结果相当，使自体腓骨长肌腱移植成为传统自体腘绳肌腱移植的一个有前景的替代方案。需要长期随访和更高质量的研究来支持我们的结果，并进一步研究自体腓骨长肌腱移植与自体腘绳肌腱移植之间的差异。
三级。
