自体移植物选择与≤25岁患者对侧ACL损伤风险的关联：系统综述与Meta分析
简介
本研究对≤25岁患者初次ACL重建术后对侧ACL损伤风险进行系统综述和Meta分析，纳入22项研究共4435例患者（骨-髌腱-骨2349例、腘绳肌腱1561例、股四头肌腱525例）。关键发现：三种自体移植物术后对侧ACL损伤总体发生率无显著差异（10.6%），其中腘绳肌腱组10.8%、骨-髌腱-骨组10.5%、股四头肌腱组12.2%。但性别是重要修饰因素：男…
英文摘要
BACKGROUND: Understanding the risk of secondary contralateral (CL) anterior cruciate ligament (ACL) injury in young patients after ACL reconstruction (ACLR) may help identify targetable risk factors to optimize rehabilitation and return to sport. It is not clear if the autograft type used in the index procedure affects the risk of having a CL injury. Additionally, the aggregated CL injury rates across studies in young patients have not been well described. PURPOSE: To compare CL ACL injury rates by graft type in patients ≤25 years of age at a minimum follow-up of 24 months after ACLR, and to stratify CL injury rates by potential modifiers, including sex. STUDY DESIGN: Systematic review and meta-analysis; Level of evidence, 4. METHODS: A systematic review of the literature for studies reporting ACL autograft reinjury rates after ACLR using hamstring tendon (HT), bone-patellar tendon-bone (BPTB), or quadriceps tendon (QT) autograft in patients ≤25 years of age with a minimum follow-up of 24 months was conducted. From this data set, CL ACL injury rates from studies in which they were reported were evaluated. RESULTS: The meta-analysis included 22 studies pooling 4435 total patients who received BPTB (n = 2349), HT (n = 1561), or QT (n = 525) autografts for their ALCR. The pooled CL ACL injury rate was 10.8% (95% CI, 8.2%-14.0%) for HT, 10.5% (95% CI, 7.4%-14.8%) for BPTB, 12.2% (95% CI, 9.7%-15.3%) for QT, and 10.6% (95% CI, 8.8%-12.8%) for all grafts together. There were no differences among primary ACLR graft types in CL ACL injury rates (χ2 = 0.7; P = .7). There were differences in CL injury rates by sex among graft types (risk ratio [RR], 0.8; 95% CI, 0.5-1.4; χ2 = 9.2; P < .01). Males had a significantly lower risk of CL ACL injury relative to females after primary BPTB ACLR (RR, 0.439), but not HT (RR, 1.050) or QT (RR, 1.219) ACLR. CONCLUSION: In patients ≤25 years of age, the rates of CL ACL injury are similar after primary HT, BPTB, and QT autograft ACLR. The risk of CL injury was lower in males relative to females after ACLR with BPTB, but not with HT or QT.