Overlapping systematic reviews of anterior cruciate ligament reconstruction comparing hamstring autograft with bone-patellar tendon-bone autograft: Why are they different?
Overlapping systematic reviews of anterior cruciate ligament reconstruction comparing hamstring autograft with bone-patellar tendon-bone autograft: Why are they different?
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DOI：
10.2106/jbjs.f.01292
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发表时间：
2007-07-01
影响因子：
5.3
通讯作者：
Bhandari, Mohit
中科院分区：
文献类型：
--
作者：
Poolman, Rudolf W.;Abouali, Jihad A. K.;Bhandari, Mohit
背景：在相似的时间段内发表的关于同一主题的系统评价（即，重叠的综述）对前交叉韧带重建的研究使骨-髌腱-骨或腘绳肌腱自体移植物的选择变得复杂。我们的目的是评估重叠的系统评价之间的差异的原因，并评估报告和内部validity.Methods的质量：我们进行了检索MEDLINE，科克伦数据库的系统评价，和EMBASE识别系统评价，其中骨髌腱骨移植物进行了比较，自体腘绳肌腱移植重建前交叉韧带。我们评估了重叠评论中的交叉引用以及作者重复评论的理由。采用Meta分析报告质量（QUOROM）评价报告质量，采用Oxman和Guyatt方法学质量指数评价内部效度。评估员的一致性与组内相关系数进行了评价。我们评估了敏感性分析，已在reviews.Results：我们确定了11重叠的系统评价。3篇综述支持髌腱移植物的稳定性，1篇支持腘绳肌移植物。6篇综述支持腘绳肌移植物预防膝关节前疼痛，其余均无结论。只有六篇评论引用了之前发表的关于同一主题的系统性评论，其中只有两篇评论引用了当时所有可用的系统性评论。报告的质量范围从5到18（中位数，12;最高分，18）。内部效度范围为1 - 7（中位数，2;最高分，7）。评价者几乎完全一致（组内相关系数为0.83和0.94）。正式的敏感性分析很少使用。最高质量的审查有利于腘绳肌移植，以防止前膝关节疼痛，并显示弱证据表明，骨髌腱骨移植产生更好的stability.Conclusions：当重叠或不一致的系统评价遇到，每个审查必须评估其方法质量的基础上，才可以用来指导临床决策或政策制定。目前可用的最佳证据，来自方法学上合理的荟萃分析，表明腘绳肌腱自体移植物在预防膝前疼痛方面具有上级优势，骨-髌腱-骨自体移植物提供更好的稳定性的证据有限。
Background: Systematic reviews published on the same topic during a similar period of time (i.e., overlapping reviews) on anterior cruciate ligament reconstruction complicate the choice between bone-patellar tendon-bone or hamstring tendon autograft. We aimed to evaluate reasons for differences among the overlapping systematic reviews and to assess the quality of reporting and internal validity.Methods: We performed a search of MEDLINE, the Cochrane Database of Systematic Reviews, and EMBASE to identify systematic reviews in which bone-patellar tendon-bone graft was compared with hamstring tendon autograft for reconstruction of the anterior cruciate ligament. We evaluated cross-citations among the overlapping reviews and the authors' rationale for repeating the review. The quality of reporting was assessed with the Quality of Reporting of Meta-analyses (QUOROM) statement, and the internal validity was assessed with the Oxman and Guyatt index for methodological quality by at least two assessors. Assessor agreement was evaluated with intraclass correlation coefficients. We evaluated the sensitivity analysis that had been performed in the reviews.Results: We identified eleven overlapping systematic reviews. Three reviews favored the patellar tendon graft for stability, and one favored the hamstring graft. Six reviews favored the hamstring graft to prevent anterior knee pain, and the rest were inconclusive. Only six reviews cited previously published systematic reviews on the same topic, and only two of these reviews cited all available systematic reviews that were available at that time. The quality of reporting ranged from 5 to 18 (median, 12; maximum score, 18). The internal validity ranged from 1 to 7 (median, 2; maximum score, 7). Reviewers reached almost perfect agreement (intraclass correlation coefficients, 0.83 and 0.94). Formal sensitivity analysis was utilized infrequently. The highest-quality review favored hamstring grafts to prevent anterior knee pain and showed weak evidence that bone-patellar tendon-bone grafts yielded better stability.Conclusions: When overlapping or discordant systematic reviews are encountered, each review must be appraised on the basis of its methodological quality before it can be used to guide clinical decision-making or policy making. The currently available best evidence, derived from a methodologically sound meta-analysis, suggests that hamstring tendon autografts are superior for preventing anterior knee pain, and there is limited evidence that bone-patellar tendon-bone autografts provide better stability.