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Quadriceps Tendon Autograft Versus Bone–Patellar Tendon–Bone and Hamstring Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis
The American Journal of Sports Medicine ( IF 4.8 ) Pub Date : 2021-09-08 , DOI: 10.1177/03635465211030259
Wenli Dai 1 , Xi Leng 2 , Jian Wang 3 , Jin Cheng 1 , Xiaoqing Hu 1 , Yingfang Ao 1
Affiliation  

Background:

The best type of autograft for anterior cruciate ligament (ACL) reconstruction remains debatable.

Hypothesis:

Compared with bone–patellar tendon–bone (BPTB) and hamstring tendon (HT) autografts, the quadriceps tendon (QT) autograft has comparable graft survival as well as clinical function and pain outcomes.

Study Design:

Meta-analysis; Level of evidence, 4.

Methods:

A systematic literature search was conducted in PubMed, Embase, Scopus, and the Cochrane Library to July 2020. Randomized controlled trials (RCTs) and observational studies reporting comparisons of QT versus BPTB or HT autografts for ACL reconstruction were included. All analyses were stratified according to study design: RCTs or observational studies.

Results:

A total of 24 studies were included: 7 RCTs and 17 observational studies. The 7 RCTs included 388 patients, and the 17 observational studies included 19,196 patients. No significant differences in graft failure (P = .36), the International Knee Documentation Committee (IKDC) subjective score (P = .39), or the side-to-side difference in stability (P = .60) were noted between QT and BPTB autografts. However, a significant reduction in donor site morbidity was noted in the QT group compared with the BPTB group (risk ratio [RR], 0.17 [95% CI, 0.09-0.33]; P < .001). No significant differences in graft failure (P = .57), the IKDC subjective score (P = .25), or the side-to-side stability difference (P = .98) were noted between QT and HT autografts. However, the QT autograft was associated with a significantly lower rate of donor site morbidity than the HT autograft (RR, 0.60 [95% CI, 0.39-0.93]; P = .02). A similar graft failure rate between the QT and control groups was observed after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. However, a significantly lower rate of donor site morbidity was observed in the QT group compared with the control group after both early and late full weightbearing, after early and late full range of motion, and after using the QT autograft with a bone plug and all soft tissue QT grafts. No difference in effect estimates was seen between RCTs and observational studies.

Conclusion:

The QT autograft had comparable graft survival, functional outcomes, and stability outcomes compared with BPTB and HT autografts. However, donor site morbidity was significantly worse with the QT autograft than with BPTB and HT autografts.



中文翻译:

自体股四头肌腱与骨-髌腱-骨和腘绳肌腱移植物用于前交叉韧带重建:系统评价和荟萃分析

背景:

用于前交叉韧带 (ACL) 重建的最佳自体移植物类型仍有争议。

假设:

与骨-髌腱-骨 (BPTB) 和腘绳肌腱 (HT) 自体移植物相比,自体股四头肌腱 (QT) 移植物具有相当的移植物存活率以及临床功能和疼痛结果。

学习规划:

荟萃分析;证据水平,4。

方法:

截至 2020 年 7 月,在 PubMed、Embase、Scopus 和 Cochrane Library 中进行了系统的文献检索。随机对照试验 (RCT) 和观察性研究报告了 QT 与 BPTB 或 HT 自体移植物用于 ACL 重建的比较。所有分析均根据研究设计进行分层:随机对照试验或观察性研究。

结果:

共纳入 24 项研究:7 项 RCT 和 17 项观察性研究。7 项 RCT 包括 388 名患者,17 项观察性研究包括 19,196 名患者。QT 之间的移植失败 ( P = .36)、国际膝关节文献委员会 (IKDC) 主观评分 ( P = .39) 或稳定性的左右差异 ( P = .60) 没有显着差异和 BPTB 自体移植物。然而,与 BPTB 组相比,QT 组的供区发病率显着降低(风险比 [RR],0.17 [95% CI,0.09-0.33];P < .001)。移植失败(P = .57)、IKDC 主观评分(P= .25),或 QT 和 HT 自体移植之间的左右稳定性差异 ( P = .98)。然而,自体 QT 移植物的供体部位发病率明显低于自体 HT 移植物(RR,0.60 [95% CI,0.39-0.93];P= .02)。在早期和晚期完全负重、早期和晚期全范围运动以及使用带骨栓的自体 QT 移植物和所有软组织 QT 移植物后,观察到 QT 组和对照组之间的移植失败率相似。然而,与对照组相比,QT 组在早期和晚期完全负重、早期和晚期全范围运动以及使用带骨栓的 QT 自体移植物后,供区发病率显着低于对照组。软组织 QT 移植物。RCT 和观察性研究之间的效果估计值没有差异。

结论:

与 BPTB 和 HT 自体移植物相比,QT 自体移植物具有相当的移植物存活率、功能结果和稳定性结果。然而,自体 QT 移植物的供区发病率明显低于自体 BPTB 和 HT 自体移植物。

更新日期:2021-09-08
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