用骨-髌腱-骨自体移植进行前交叉韧带重建后，膝关节前部疼痛的发生率为 18.0% 至 48.0%，跪地疼痛的发生率为 10.0% 至 62.0%：一级研究的系统回顾

Q3 Medicine Arthroscopy Sports Medicine and Rehabilitation Pub Date : 2024-02-02 DOI:10.1016/j.asmr.2024.100902

Liam A. Peebles B.A. , Ramesses A. Akamefula B.S. , Zachary S. Aman B.A. , Arjun Verma B.S. , Anthony J. Scillia M.D. , Mary K. Mulcahey M.D. , Matthew J. Kraeutler M.D.

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引用次数: 0

摘要

目的(1)对I级随机对照试验（RCT）进行系统回顾，详细了解使用骨-髌腱-骨（BPTB）自体移植物进行前交叉韧带重建（ACLR）后膝关节前部疼痛和跪位疼痛的发生率；(2)研究在髌骨取材部位植骨对膝关节前部疼痛和跪位疼痛的影响。方法根据《系统综述和荟萃分析首选报告项目》指南，对 1980 年至 2023 年的 I 级研究进行了系统综述。评估的主要结果是供体部位是否出现膝前疼痛或膝关节疼痛。我们还进行了一项次要子分析，以评估接受前交叉韧带置换术（ACLR）的 BPTB 患者组与接受取骨部位植骨术的患者组之间术后疼痛发生率的差异。患者的平均随访时间为 4.78 年（2.0-15.3 年），平均年龄为 21.7 岁至 38 岁。根据 10 项研究中 354 名患者的情况计算，膝关节前侧疼痛的发生率从 5.4% 到 48.4% 不等。在 9 项研究的 490 名患者中，术后下跪疼痛的发生率从 4.0% 到 75.6% 不等。结论根据目前的 I 级 RCT 数据，使用 BPTB 自体移植物进行 ACLR 后，膝关节前部疼痛和跪位疼痛的发生率分别为 5.4% 至 48.4% 和 4.0% 至 75.6%。

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Following Anterior Cruciate Ligament Reconstruction With Bone–Patellar Tendon–Bone Autograft, the Incidence of Anterior Knee Pain Ranges From 5.4% to 48.4% and the Incidence of Kneeling Pain Ranges From 4.0% to 75.6%: A Systematic Review of Level I Studies

Purpose

To (1) perform a systematic review of level I randomized controlled trials (RCTs) detailing the incidence of anterior knee pain and kneeling pain following anterior cruciate ligament reconstruction (ACLR) with bone–patellar tendon–bone (BPTB) autograft and (2) investigate the effect of bone grafting the patellar harvest site on anterior knee and kneeling pain.

Methods

A systematic review of level I studies from 1980 to 2023 was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The primary outcome evaluated was the presence of donor site morbidity in the form of anterior knee pain or kneeling pain. A secondary subanalysis was performed to assess for differences in the incidence of postoperative pain between patient groups undergoing ACLR with BPTB receiving harvest site bone grafting and those in whom the defect was left untreated.

Results

Following full-text review, 15 studies reporting on a total of 696 patients met final inclusion criteria. Patients were followed for an average of 4.78 years (range, 2.0-15.3), and the mean age ranged from 21.7 to 38 years old. The incidence of anterior knee pain, calculated from 354 patients across 10 studies, ranged from 5.4% to 48.4%. The incidence of postoperative pain with kneeling was determined to range from 4.0% to 75.6% in 490 patients from 9 studies. Patients treated with bone grafting of the BPTB harvest site had no significant difference in incidence of any knee pain compared with those who were not grafted, with incidences of 43.3% and 40.2%, respectively.

Conclusions

Based on the current level I RCT data, the incidences of anterior knee pain and kneeling pain following ACLR with BPTB autograft range from 5.4% to 48.4% and 4.0% to 75.6%, respectively.