Background:Medial collateral ligament (MCL) reconstruction (MCLR) is performed after failed nonoperative treatment or high-grade MCL injury with associated valgus instability.Purpose:To evaluate clinical outcomes after MCLR with autograft versus allograft.Study Design:Systematic review, Level of evidence, 4.Methods:A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The authors conducted a search of the PubMed, CINAHL, EMBASE, and Cochrane databases to identify studies comparing outcomes of MCLR with autograft versus allograft. Studies were included if they evaluated clinical outcomes after MCLR using autograft and/or allograft. Any study that included concomitant knee ligament injury other than the anterior cruciate ligament injury was excluded. A quality assessment was performed using the modified Coleman Methodology Score.Results:The initial search identified 746 studies, 17 of which met the inclusion criteria and were included in this review. The studies included 307 patients: 151 (49.2%) patients received autografts, and 156 (50.8%) received allografts. The most used autograft was the semitendinosus tendon (136 grafts; 90.1% of specified allografts), and the only allograft used was the Achilles tendon (110 grafts; 100% of specified autografts). The mean follow-up of the studies was 25.6 months. Postoperative pain (Lysholm scores) ranged from 82.9 to 94.8 in patients receiving autografts and 87.5 to 93 in patients receiving allografts. Postoperative range of motion was full in 8 of 15 (53.3%) patients receiving autografts compared with 82 of 93 (88.2%) patients receiving allografts. Five of the 151 (3.3%) patients who had MCLR with autografts had complications such as infection, instability, and prominent screws. Two of the 156 (1.3%) MCLRs with allografts developed complications of prominent screws and nonhealing incisions.Conclusion:MCLR with either autografts or allografts leads to improved patient-reported, radiographic, and clinical outcomes. Patient-reported postoperative pain was similar in patients receiving either graft type. Other outcomes were difficult to compare between graft types because of nonstandardized reporting and a lack of pre- and postoperative measurements. Therefore, there is no evidence of significantly improved outcomes in the use of either autograft or allograft with MCLR.

中文翻译：

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自体移植与同种异体移植的内侧副韧带重建：系统评价


背景：内侧副韧带 (MCL) 重建 (MCLR) 是在非手术治疗失败或伴有外翻不稳定的重度 MCL 损伤后进行的。目的：评估自体移植与同种异体移植进行 MCLR 后的临床结果。研究设计：系统评价、水平证据，4.方法：根据PRISMA（系统评价和荟萃分析的首选报告项目）指南进行系统评价。作者对 PubMed、CINAHL、EMBASE 和 Cochrane 数据库进行了检索，以确定比较 MCLR 与自体移植和同种异体移植结果的研究。如果研究使用自体移植物和/或同种异体移植物评估 MCLR 后的临床结果，则纳入研究。任何包括除前十字韧带损伤之外的伴随膝关节韧带损伤的研究均被排除。使用改良的科尔曼方法评分进行质量评估。结果：初步检索确定了 746 项研究，其中 17 项符合纳入标准并纳入本次综述。这些研究包括 307 名患者：151 名患者（49.2%）接受自体移植，156 名患者（50.8%）接受同种异体移植。最常用的自体移植物是半腱肌腱（136 个移植物；占指定同种异体移植物的 90.1%），唯一使用的同种异体移植物是跟腱（110 个移植物；占指定自体移植物的 100%）。研究的平均随访时间为 25.6 个月。接受自体移植患者的术后疼痛（Lysholm 评分）范围为 82.9 至 94.8，接受同种异体移植患者的术后疼痛范围为 87.5 至 93。接受自体移植的 15 名患者中有 8 名 (53.3%) 术后活动范围完全，而接受同种异体移植的 93 名患者中有 82 名 (88.2%) 术后活动范围完全。 151 人中的 5 人（3.3%）接受自体移植 MCLR 的患者出现感染、不稳定和螺钉突出等并发症。 156 例 (1.3%) MCLR 中的 2 例出现了螺钉突出和切口不愈合等并发症。结论：无论是自体移植还是同种异体移植的 MCLR 均可改善患者报告、影像学和临床结果。接受任一移植类型的患者报告的术后疼痛相似。由于报告不标准化以及缺乏术前和术后测量，其他结果很难在移植类型之间进行比较。因此，没有证据表明使用 MCLR 的自体移植物或同种异体移植物可显着改善结果。