Outcomes of Anterior Cruciate Ligament Reconstruction Using Single-Bundle Versus Double-Bundle Technique: Meta-analysis of 19 Randomized Controlled Trials
Outcomes of Anterior Cruciate Ligament Reconstruction Using Single-Bundle Versus Double-Bundle Technique: Meta-analysis of 19 Randomized Controlled Trials
复制标题
使用单束与双束技术重建前十字韧带的结果：19 项随机对照试验的荟萃分析
DOI：
10.1016/j.arthro.2012.08.024
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发表时间：
2013-02-01
影响因子：
4.7
通讯作者：
Lei, Guanghua
中科院分区：
文献类型：
--
作者：
Xu, Mai;Gao, Shuguang;Lei, Guanghua
目的：本研究的目的是验证双束前交叉韧带重建比单束技术在稳定性和功能恢复方面有更好的改善的假设。方法：检索Pubmed、Embase、AMED、Cochrane Library、CNKI、万方、VIP等数据库，检索已发表的双束与单束技术治疗前交叉韧带重建的随机对照试验。稳定性改善和功能恢复的结果进行meta分析。结果：19项随机对照试验的1667例患者被纳入meta分析。在pivot shift试验和国际膝关节文献委员会（IKDC）客观评分中，用随机效应模型计算的单束与双束ACL重建的总体相对风险（95%置信区间）分别为0.77（0.67,0.89）和0.80（0.68,0.93）。Lachman检验中采用固定效应模型计算的总体相对危险度为0.84（0.78 ~ 0.92）。采用随机效应模型计算的总体标准均值差（95%置信区间）为0.26 (0.05,0.46)；Lysholm评分为-0.08 (-0.28,0.12)；Tegner活动量表，Tegner活动评分为-0.41 (-0.85,0.03)；IKDC主观评分-0.08（-0.32,0.15）。结论：随机对照试验荟萃分析显示，与单束前交叉韧带重建相比，双束前交叉韧带重建的前路和旋转稳定性明显更好，IKDC客观评分更高。然而，meta分析未发现双束和单束重建在主观结果测量上有任何显著差异，Lysholm评分、Tegner活动量表和IKDC主观评分证明了这一点。证据水平：二级，一级和二级研究的荟萃分析。
Purpose: The purpose of this study was to test the hypothesis that double-bundle anterior cruciate ligament reconstruction yields better improvement in stability and functional recovery than the single-bundle technique. Methods: An Internet search was performed of the Pubmed, Embase, AMED, Cochrane Library, CNKI, Wanfang and VIP databases to find all published randomized controlled trials of anterior cruciate ligament reconstruction treated with the double-bundle versus single-bundle technique. Outcomes of stability improvement and functional recovery were meta-analyzed. Results: One thousand six hundred sixty-seven patients in 19 randomized controlled trials were involved in the meta-analysis. The overall relative risk (with 95% confidence interval) calculated with the random effects model in the pivot shift test and the International Knee Documentation Committee (IKDC) objective score for single-bundle versus double-bundle ACL reconstruction were 0.77 (0.67, 0.89) and 0.80 (0.68, 0.93), respectively. The overall relative risk calculated with the fixed effects model in the Lachman test was 0.84 (0.78 to 0.92). The overall standard mean differences (with 95% confidence interval) calculated with the random effects model were 0.26 (0.05, 0.46) for anterior side-to-side difference; -0.08 (-0.28, 0.12) for Lysholm score; Tegner activity scale, -0.41 (-0.85, 0.03) for Tegner activity score; and -0.08 (-0.32, 0.15) for IKDC subjective score. Conclusions: Meta-analysis of random controlled trials revealed that double-bundle anterior cruciate ligament reconstruction resulted in significantly better anterior and rotational stability and higher IKDC objective scores compared with single-bundle reconstruction. However, the meta-analysis did not detect any significant differences in subjective outcome measures between double-bundle and single-bundle reconstruction, as evidenced by the Lysholm score, Tegner activity scale, and IKDC subjective score. Level of Evidence: Level II, meta-analysis of Level I and II studies.