Does autograft choice determine intermediate-term outcome of ACL reconstruction?
Does autograft choice determine intermediate-term outcome of ACL reconstruction?
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DOI：
10.1007/s00167-010-1277-z
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发表时间：
2011-03
影响因子：
3.8
通讯作者：
Spindler, Kurt P.
中科院分区：
文献类型：
--
作者：
Magnussen, Robert A.;Carey, James L.;Spindler, Kurt P.
许多临床研究和系统综述比较了前交叉韧带重建与腿筋和髌骨肌腱自体移植的短期（2年）结果。除了髌骨肌腱移植物增加膝痛外，观察到的差异很少。本系统综述的目的是确定在ACL重建后至少5年内，基于移植物选择的临床、患者报告或影像学结果的差异。系统回顾了所有比较髌骨肌腱和腘绳肌腱自体ACL重建的前瞻性研究，随访时间至少为5年。确定了7项研究，并对选定的数据进行了荟萃分析，确定这些数据具有充分的同质性（失败和松散）。5个随机对照试验和2个前瞻性队列比较腘绳肌腱和髌骨肌腱自体移植物。临床评估[失败率、国际膝关节文献委员会（IKDC）分级、Lachman、pivot shift和KT 1000试验]显示两种移植物之间没有差异。患者报告的结果（Lysholm、Cincinnati和IKDC）没有差异。膝关节前疼痛（3/3项研究）和膝关节疼痛（4/4项研究）在髌腱组更常见。然而，这些研究中患者报告的结果并没有什么不同。骨性关节炎的影像学证据在自体移植物的选择上是不一致的。这项二级系统评价显示，除了膝关节前部和膝盖疼痛增加外，不同移植物类型的主要临床结果没有差异。髌骨肌腱组存在骨关节炎发病率增加的可能性，但需要增加样本量。这些长期结果与之前系统评价的2年随访结果相似。
Many clinical studies and systematic reviews have compared the short-term (2 year) outcomes of ACL reconstruction with hamstring and patellar tendon autograft. Few differences have been observed, with the exception of increased kneeling pain with patellar tendon grafts. The goal of this systematic review is to determine where there are differences in clinical, patient reported, or radiographic outcomes based on graft choice at a minimum of 5 years after ACL reconstruction. A systematic review was performed to identify all prospective outcome studies comparing patellar tendon and hamstring autograft ACL reconstruction with minimum follow-up of at least five years. Seven studies were identified and meta-analysis of select data determined to be sufficiently homogenous was performed (failure and laxity). Five randomized controlled trials and two prospective cohorts comparing hamstring and patellar tendon autografts were identified. Clinical assessment [failure rate, International Knee Documentation Committee (IKDC) class, Lachman, pivot shift, and KT 1000 testing] showed no difference between grafts. Patient-reported outcomes (Lysholm, Cincinnati, and IKDC) showed no difference. Both anterior knee pain (3/3 studies) and kneeling pain (4/4 studies) were more frequent in the patellar tendon group. However, the patient-reported outcomes in these studies were not different. Radiographic evidence of osteoarthritis was inconsistent between autograft choices. This Level II systematic review demonstrates no difference in major clinical results between graft types with the exception of increased anterior knee and kneeling pain. There exists a potential for increased incidence of osteoarthritis in the patellar tendon group but increased sample size is required. These longer-term outcomes are similar to results of prior systematic reviews with two-year follow-up.
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作者：
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10.1016/j.arthro.2004.12.002
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影响因子：
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