桥接增强前交叉韧带修复与自体移植物重建在前交叉韧带手术中的对比
简介
该系统综述比较桥接增强ACL修复（BEAR）与自体移植物重建的证据。BEAR术后2年评分及前后向松弛度不劣于自体重建，腘绳肌肌力更佳，但同侧二次ACL手术数（数值上）更多；自体重建适用于各撕裂类型、慢性损伤、翻修及高危运动员。BEAR宜限于急性、可修复且胫骨残端及组织质量良好的撕裂，其余情况优先自体移植物重建。
英文摘要
INTRODUCTION: Surgical repair of the anterior cruciate ligament (ACL) using an autograft is the accepted standard treatment for symptomatic ACL tears, but morbidity associated with the harvest of the autograft, residual laxity, and the possibility of a second injury and post-traumatic osteoarthritis have brought about renewed interest in biologic repair. Bridge-enhanced ACL repair (BEAR) employs an extracellular matrix, resorbable implant, and autologous blood to promote healing of the native ligament. MATERIALS AND METHODS: The PubMed, Embase, Cochrane Library, and Scopus databases were queried for English-language papers from January 2019 until June 2026, with a selection of landmark papers in translation retained. The highest priority evidence included randomized trials, prospective cohort studies, registries, systematic reviews, consensus statements, and mechanistic animal studies. The narrative synthesis was conducted in line with the SANRA principles. RESULTS: BEAR is supported by a prospective randomized trial demonstrating noninferior 2-year score and instrumented anteroposterior laxity versus autograft reconstruction, and higher hamstring strength with a higher number of ipsilateral second ACL surgeries (numerically) in BEAR. There are small or short-term early registry results and 6-year first-in-human data that are encouraging. Autograft reconstruction is versatile in all patterns, chronic injuries, revision scenarios, and high-risk athletes. Bone-patellar tendon-bone autograft may have a lower revision risk for young pivoting athletes. At the same time, hamstring harvest may result in lower strength, and a smaller autograft may result in a higher failure risk. CONCLUSION: BEAR should be used as a selective repair option for patients with acute and repairable ACL tears, and good tibial stump and tissue quality. The indication is unclear, chronicity is long, the risk of instability is high, or revision predictability is high, and the autograft reconstruction is preferred.