Background:

Comprehensive studies evaluating quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction are lacking. The optimal choice of graft between bone–patellar tendon–bone (BPTB), hamstring tendon (HT), and QT is still debatable.

Hypothesis:

The current literature supports the use of QT as a strong autograft with good outcomes when used in ACL reconstruction.

Study Design:

Meta-analysis; Level of evidence, 2.

Methods:

A systematic search of the literature was performed in PubMed, MEDLINE, Cochrane, and Ovid databases to identify published articles on clinical studies relevant to ACL reconstruction with QT autograft and studies comparing QT autograft versus BPTB and HT autografts. The results of the eligible studies were analyzed in terms of instrumented laxity measurements, Lachman test, pivot-shift test, Lysholm score, objective and subjective International Knee Documentation committee (IKDC) scores, donor-site pain, and graft failure.

Results:

Twenty-seven clinical studies including 2856 patients with ACL reconstruction met the inclusion criteria. Comparison of 581 QT versus 514 BPTB autografts showed no significant differences in terms of instrumented mean side-to-side difference (P = .45), Lachman test (P = .76), pivot-shift test grade 0 (P = .23), pivot-shift test grade 0 or 1 (P = .85), mean Lysholm score (P = .1), mean subjective IKDC score (P = .36), or graft failure (P = .50). However, outcomes in favor of QT were found in terms of less donor-site pain (risk ratio for QT vs BPTB groups, 0.25; 95% CI, 0.18-0.36; P < .00001). Comparison of 181 QT versus 176 HT autografts showed no significant differences in terms of instrumented mean side-to-side difference (P = .75), Lachman test (P = .41), pivot-shift test grade 0 (P = .53), Lysholm score less than 84 (P = .53), mean subjective IKDC score (P = .13), donor-site pain (P = .40), or graft failure (P = .46). However, outcomes in favor of QT were found in terms of mean Lysholm score (mean difference between QT and HT groups, 3.81; 95% CI, 0.45-7.17; P = .03).

Conclusion:

QT autograft had comparable clinical and functional outcomes and graft survival rate compared with BPTB and HT autografts. However, QT autograft showed significantly less harvest site pain compared with BPTB autograft and better functional outcome scores compared with HT autograft.

中文翻译：

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前十字韧带重建：股四头肌腱移植与骨-腱腱移植和tell绳肌腱移植的系统评价和结果分析。

背景：

缺乏对四头肌腱（QT）自体移植物进行前交叉韧带（ACL）重建的评估。骨-pat腱-骨（BPTB），绳肌腱（HT）和QT之间的最佳移植选择仍有待商de。

假设：

当前文献支持将QT用作强大的自体移植物，并在ACL重建中使用时效果良好。

学习规划：

荟萃分析；证据水平2。

方法：

在PubMed，MEDLINE，Cochrane和Ovid数据库中进行了系统的文献检索，以鉴定与QT自体移植重建ACL相关的临床研究的已发表文章，以及比较QT自体移植与BPTB和HT自体移植的研究。通过仪器测量的松弛度，Lachman测试，枢轴移位测试，Lysholm得分，客观和主观的国际膝盖文档委员会（IKDC）得分，供体部位疼痛和移植失败，对符合条件的研究结果进行了分析。

结果：

包括2856例ACL重建患者在内的27项临床研究符合纳入标准。比较581 QT和514 BPTB自体移植在仪器平均侧向差异（P = .45），Lachman测试（P = .76），枢轴位移测试等级0（P = .23 ）方面无显着差异。），0级或1级枢轴移位测试（P = .85），平均Lysholm评分（P = .1），平均主观IKDC评分（P = .36）或移植失败（P = .50）。但是，发现有利于QT的结果是减少了供体部位的疼痛（QT与BPTB组的风​​险比为0.25； 95％CI为0.18-0.36；P<.00001）。比较181个QT和176个HT自体移植物，在仪器化的平均左右差异（P = .75），Lachman测试（P = .41），枢轴位移测试等级0（P = .53 ）方面无显着差异。），Lysholm评分低于84（P = .53），平均主观IKDC评分（P = .13），供体部位疼痛（P = .40）或移植失败（P = .46）。然而，以平均Lysholm评分发现了支持QT的结局（QT和HT组之间的平均差异为3.81； 95％CI为0.45-7.17；P = .03）。

结论：

与BPTB和HT自体移植相比，QT自体移植具有可比的临床和功能结局以及移植存活率。然而，与HTTB移植相比，QT自移植显示出的收获部位疼痛明显少于BPTB自移植，并且功能结局评分更高。