Patellar Tendon Versus Hamstring Tendon Autografts for Reconstructing the Anterior Cruciate Ligament A Meta-Analysis Based on Individual Patient Data

被引：96

作者：

Biau, David Jean ^{[1
,2
]}

Katsahian, Sandrine ^{[2
]}

Kartus, Juri ^{[3
]}

Harilainen, Arsi ^{[4
]}

Feller, Julian A. ^{[5
]}

Sajovic, Matjaz ^{[6
]}

Ejerhed, Lars ^{[7
]}

Zaffagnini, Stefano ^{[8
]}

Roepke, Martin ^{[9
]}

Nizard, Remy ^{[10
]}

机构：

[1] Univ Paris 05, Hop Cochin, AP HP, Serv Chirurg Orthoped & Traumatol, F-75679 Paris, France

[2] Univ Paris Diderot, Hop St Louis, AP HP, INSERM,Dept Biostat & Informat Med,UMR S 717, Paris, France

[3] NAL Hosp, Dept Orthopaed, Trollhattan, Sweden

[4] ORTON Orthopaed Hosp, Invalid Fdn, Helsinki, Finland

[5] La Trobe Univ, Musculoskeletal Res Ctr, Bundoora, Vic, Australia

[6] Gen Hosp Celje, Celje, Slovenia

[7] Uddevalla Cent Hosp, Dept Orthopaed, Uddevalla, Sweden

[8] Rizzoli Orthopaed Inst, Biomech Dept, Bologna, Italy

[9] Otto VonGuericke Univ Magdegurg, Orthopad Klin, D-39016 Magdeburg, Germany

[10] Univ Paris Diderot, Hop Lariboisiere, AP HP, Serv Chirurg Orthoped & Traumatol, Paris, France

来源：

AMERICAN JOURNAL OF SPORTS MEDICINE | 2009年 / 37卷 / 12期

关键词：

anterior cruciate ligament (ACL); reconstruction; patellar tendon; hamstring tendon; meta-analysis; GRAFT FIXATION DEVICES; ACL RECONSTRUCTION; FOLLOW-UP; PIVOT SHIFT; ORTHOPEDIC-SURGEONS; INSERTION TORQUE; TUNNEL PLACEMENT; GRACILIS TENDON; TIBIAL TUNNEL; BONE;

D O I：

10.1177/0363546509333006

中图分类号：

R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学（修复外科学）];

学科分类号：

100224 [整形外科学];

摘要：

Background: The best means of ensuring knee stability after anterior cruciate ligament (ACL) reconstruction remains a core debate in sports medicine. Hypothesis: There is no difference between ACL reconstruction with patellar tendon or hamstring tendon autografts with regard to postoperative knee laxity and instability. Study Design: Meta-analysis of individual patient data. Methods: Pooled analysis of individual patient data from 6 published randomized clinical trials included 423 patients with symptomatic unilateral anterior cruciate ligament injury randomly assigned to reconstruction with patellar tendon or hamstring tendon autograft. Knee instability, defined as a positive pivot-shift test result, was the primary outcome, and knee laxity, defined as a positive Lachman test result, was the secondary outcome. Odds ratios were computed before and after adjustment for potential confounders and trial effect. Regression analyses were performed to look for effects of covariates on outcomes, and mixed-effects models were used to account for a trial effect. Sensitivity analyses were conducted to explore the effects of missing data and excluding each trial. Results: Anterior cruciate ligament reconstruction with patellar tendon autograft was significantly associated with a decreased risk of a positive pivot-shift test result (adjusted odds ratio, 0.46; 95% confidence interval, 0.24-0.86; P = .016). The risk of having a positive Lachman test result was not significantly different between the 2 groups. The estimated treatment effect was not substantially changed by differences in handling missing data or exclusion of any of the trials. A positive pivot-shift test result was more common in female (P = .003) and younger patients (P = .017). Conclusion: Postoperative knee instability was less common after ACL reconstruction with patellar tendon autograft than with hamstring tendon autograft.

引用

页码：2470 / 2478

页数：9

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