Autograft superior to both irradiated and non-irradiated allograft for primary ACL reconstruction: a systematic review
Notice bibliographique
Résumé
ImportanceGraft choice in anterior cruciate ligament (ACL) reconstruction is controversial. Recent evidence questions the equivalence of non-irradiated allografts to autografts in primary reconstruction.AimTo compare the clinical outcomes of primary ACL reconstruction using autografts and allografts.Evidence reviewA computerised search of the Pubmed/Medline, Cochrane Central Register of Controlled Trials, and SCOPUS databases was performed. We included comparative studies with level of evidence I to III, minimum 2 year follow-up, a minimum of 20 patients in each treatment arm, and selected outcome measures. Non-irradiated, non-chemically treated allografts and irradiated or chemically treated allografts were compared with autografts. The Cochrane Collaboration tool was used for quality appraisal.FindingsTwenty-two studies were included for the systematic review. These included 1148 autografts, 939 non-irradiated, non-chemically treated allografts, and 308 irradiated or chemically treated allografts. The failure rates for both allograft groups were inferior to that of autograft, with the OR for failure favouring autografts versus non-irradiated, non-chemically treated allografts (OR 0.51, 95% CI 0.30 to 0.88), and irradiated or chemically treated allografts (OR 0.12, 95% CI 0.06 to 0.21). Other outcome measures, including the Lachman test, pivot shift, instrumented laxity testing, and IKDC scores demonstrated no statistically significant differences for autograft and non-irradiated, non-chemically treated allograft reconstructions. Irradiated and chemically treated allograft reconstructions were inferior to autograft reconstructions in almost every examined outcome measure.Conclusions and relevanceIn this level III systematic review, autograft reconstructions have a lower failure rate than both non-irradiated and irradiated allografts, particularly for younger patients. Other clinical outcome measures for autografts and non-irradiated allografts are not significantly different. Based on our results, it appears that irradiated and chemically-treated allografts have clearly inferior results, and surgeons should exercise caution when recommending ACL reconstruction with these allografts.Level of evidenceIII. Graft choice in anterior cruciate ligament (ACL) reconstruction is controversial. Recent evidence questions the equivalence of non-irradiated allografts to autografts in primary reconstruction. To compare the clinical outcomes of primary ACL reconstruction using autografts and allografts. A computerised search of the Pubmed/Medline, Cochrane Central Register of Controlled Trials, and SCOPUS databases was performed. We included comparative studies with level of evidence I to III, minimum 2 year follow-up, a minimum of 20 patients in each treatment arm, and selected outcome measures. Non-irradiated, non-chemically treated allografts and irradiated or chemically treated allografts were compared with autografts. The Cochrane Collaboration tool was used for quality appraisal. Twenty-two studies were included for the systematic review. These included 1148 autografts, 939 non-irradiated, non-chemically treated allografts, and 308 irradiated or chemically treated allografts. The failure rates for both allograft groups were inferior to that of autograft, with the OR for failure favouring autografts versus non-irradiated, non-chemically treated allografts (OR 0.51, 95% CI 0.30 to 0.88), and irradiated or chemically treated allografts (OR 0.12, 95% CI 0.06 to 0.21). Other outcome measures, including the Lachman test, pivot shift, instrumented laxity testing, and IKDC scores demonstrated no statistically significant differences for autograft and non-irradiated, non-chemically treated allograft reconstructions. Irradiated and chemically treated allograft reconstructions were inferior to autograft reconstructions in almost every examined outcome measure. In this level III systematic review, autograft reconstructions have a lower failure rate than both non-irradiated and irradiated allografts, particularly for younger patients. Other clinical outcome measures for autografts and non-irradiated allografts are not significantly different. Based on our results, it appears that irradiated and chemically-treated allografts have clearly inferior results, and surgeons should exercise caution when recommending ACL reconstruction with these allografts.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,011 | 0,008 |
| Bibliométrie | 0,005 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».