Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis
Anatomic single- versus double-bundle ACL reconstruction: a meta-analysis
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DOI：
10.1007/s00167-013-2811-6
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发表时间：
2014-05-01
影响因子：
3.8
通讯作者：
Samuelsson, Kristian
中科院分区：
文献类型：
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作者：
Desai, Neel;Bjornsson, Haukur;Samuelsson, Kristian
目的探讨解剖双束前交叉韧带（ACL）重建与解剖单束前交叉韧带重建相比，是否能更有效地恢复前后（A-P）松弛、旋转松弛和减少移植物破裂的频率。我们的假设是，与解剖性单束前交叉韧带重建相比，解剖性双束前交叉韧带重建由于其双束张力模式导致了更好的旋转膝关节松弛和更少的移植物破裂。使用PubMed、EMBASE和Cochrane图书馆数据库进行电子检索。所有的英文治疗试验报告了膝关节运动学结果和初次解剖双束与单束前交叉韧带重建的移植物破裂率。仅纳入I-II级证据的临床研究。提取有关运动学测试的数据，包括枢轴移位测试、Lachman测试、前抽屉测试、KT-1000测量、导航测量的A-P松弛度和导航测量的总内外（IRER）松弛度，以及移植物失效频率。共纳入7154项研究，其中15篇论文（8项随机对照试验和7项前瞻性队列研究，n = 970例患者）符合入选标准。解剖前交叉韧带双束重建显示，使用KT-1000关节计测量前韧带松弛程度较低，标准平均差(SMD) = 0.36 (95% CI 0.214-0.513, p < 0.001)，使用导航测量a - p松弛程度较低（SMD = 0.29, 95% CI 0.01-0.565, p = 0.042）。与解剖性单束ACL重建相比，解剖性双束ACL重建在pivot-shift试验、Lachman试验、前抽屉试验、总IRER或移植物失败率方面没有显著改善。解剖双束前交叉韧带重建在膝关节运动学恢复方面优于解剖单束重建，主要是A-P松弛。这些松弛的改善是否会导致临床有意义的结果的长期改善仍不确定。
To determine whether anatomic double-bundle anterior cruciate ligament (ACL) reconstruction compared to anatomic single-bundle ACL reconstruction more effectively restored antero-posterior (A-P) laxity, rotatory laxity and reduced frequency of graft rupture. Our hypothesis was that anatomic double-bundle ACL reconstruction results in superior rotational knee laxity and fewer graft ruptures due to its double-bundle tension pattern, compared with anatomic single-bundle ACL reconstruction.An electronic search was performed using the PubMed, EMBASE and Cochrane Library databases. All therapeutic trials written in English reporting knee kinematic outcomes and graft rupture rates of primary anatomic double- versus single-bundle ACL reconstruction were included. Only clinical studies of levels I-II evidence were included. Data regarding kinematic tests were extracted and included pivot-shift test, Lachman test, anterior drawer test, KT-1000 measurements, A-P laxity measures using navigation and total internal-external (IRER) laxity measured using navigation, as well as graft failure frequency.A total of 7,154 studies were identified of which 15 papers (8 randomized controlled trials and 7 prospective cohort studies, n = 970 patients) met the eligibility criteria. Anatomic ACL double-bundle reconstruction demonstrated less anterior laxity using KT-1000 arthrometer with a standard mean difference (SMD) = 0.36 (95 % CI 0.214-0.513, p < 0.001) and less A-P laxity measured with navigation (SMD = 0.29 95 % CI 0.01-0.565, p = 0.042). Anatomic double-bundle ACL reconstruction did not lead to significant improvements in pivot-shift test, Lachman test, anterior drawer test, total IRER or graft failure rates compared to anatomic single-bundle ACL reconstruction.Anatomic double-bundle ACL reconstruction is superior to anatomic single-bundle reconstruction in terms of restoration of knee kinematics, primarily A-P laxity. Whether these improvements of laxity result in long-term improvement of clinical meaningful outcomes remains uncertain.II.