四股半腱肌前交叉韧带移植物与骨-髌腱-骨移植物的比较：功能结局的系统评价与荟萃分析
简介
本研究通过系统综述与Meta分析，比较了骨-髌腱-骨（BPTB）与四股腘绳肌腱自体移植物在ACL重建中的效果。共纳入10项研究（n=1029）。结果显示，四股腘绳肌腱移植物可显著减轻术后疼痛（SMD 0.44；p=0.015），并提高获得IKDC A级的可能性（OR 1.31；p=0.039）。而BPTB移植物在KT-1000测量的前向稳定性方面表现更优（S…
英文摘要
BACKGROUND: The choice of graft in anterior cruciate ligament (ACL) reconstruction influences postoperative pain, stability, and functional outcomes. Bone-patellar tendon-bone (BTB) autografts provide robust reconstructions but may increase anterior knee pain whereas quadrupled semitendinosus (ST) grafts may reduce morbidity while maintaining comparable function. However, direct comparisons of BTB and quadrupled ST remain limited. The primary objective of this systematic review and meta-analysis was to compare postoperative pain between BTB and quadrupled ST autografts. Secondary objectives were to evaluate instrumented stability (KT-1000), clinical stability (Lachman), patient-reported outcomes (Lysholm, Tegner, IKDC grades), and graft rupture rates. METHODS: Following PRISMA guidelines, MEDLINE/PubMed, EMBASE, SCOPUS, and Cochrane Central were searched through March 1, 2026, for randomized and comparative cohort studies of primary ACL reconstruction comparing BTB and quadrupled ST autografts. Eligible studies involved patients ≥16 years with or without meniscal or chondral pathology and ≥3-month follow-up. Continuous and dichotomous outcomes were pooled as mean or standardized mean differences (SMD) and odds ratios (OR) with 95% confidence interval (CI) using random-effects models. Statistical heterogeneity was quantified using I2. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for nonrandomized comparative cohort studies. RESULTS: Ten studies were included (n = 1029), comprising 692 males (67%) and 337 females (33%). The mean ages across studies ranged from 17.7 to 49.4 years, with follow-up periods spanning 6 months to 8 years. ST reduced postoperative pain (SMD 0.44; 95% CI 0.09-0.80, p = 0.015), whereas BTB improved KT-1000 stability (SMD -0.70; 95% CI -1.02 to -0.38, p < 0.0001). IKDC Grade A favored ST (OR 1.31; 95% CI 1.03-1.66, p = 0.039). Lachman, Lysholm, Tegner, and graft rupture did not differ between groups. CONCLUSION: Both BTB and quadrupled ST autografts are effective for ACL reconstruction. BTB provides greater anterior stability, while ST is associated with less postoperative pain and higher odds of achieving IKDC Grade A outcomes without increasing failure risk. These findings highlight the importance of individualized graft selection to balance mechanical stability with patient-reported recovery and donor-site morbidity.