PDF(Pubmed)
Abstract：
UNASSIGNED: Primary anterior cruciate ligament (ACL) repair has gained renewed interest in select centers for patients with proximal or midsubstance ACL tears. Therefore, it is important to reassess contemporary clinical outcomes of ACL repair to determine whether a clinical benefit exists over the gold standard of ACL reconstruction (ACLR).
UNASSIGNED: To (1) perform a meta-analysis of comparative trials to determine whether differences in clinical outcomes and adverse events exist between ACL repair versus ACLR and (2) synthesize the midterm outcomes of available trials.
UNASSIGNED: Systematic review; Level of evidence, 3.
UNASSIGNED: The PubMed, OVID/Medline, and Cochrane databases were queried in August 2023 for prospective and retrospective clinical trials comparing ACL repair and ACLR. Data pertaining to tear location, surgical technique, adverse events, and clinical outcome measures were recorded. DerSimonian-Laird random-effects models were constructed to quantitatively evaluate the association between ACL repair/ACLR, adverse events, and clinical outcomes. A subanalysis of minimum 5-year outcomes was performed.
UNASSIGNED: Twelve studies (893 patients; 464 ACLR and 429 ACL repair) were included. Random-effects models demonstrated a higher relative risk (RR) of recurrent instability/clinical failure (RR = 1.64; 95% confidence interval [CI], 1.04-2.57; P = .032), revision ACLR (RR = 1.63; 95% CI, 1.03-2.59; P = .039), and hardware removal (RR = 4.94; 95% CI, 2.10-11.61; P = .0003) in patients who underwent primary ACL repair versus ACLR. The RR of reoperations and complications (knee-related) were not significantly different between groups. No significant differences were observed when comparing patient-reported outcome scores. In studies with minimum 5-year outcomes, no significant differences in adverse events or Lysholm scores were observed.
UNASSIGNED: In contemporary comparative trials of ACL repair versus ACLR, the RR of clinical failure, revision surgery due to ACL rerupture, and hardware removal was greater for primary ACL repair compared with ACLR. There were no observed differences in patient-reported outcome scores, reoperations, or knee-related complications between approaches. In the limited literature reporting on minimum 5-year outcomes, significant differences in adverse events or the International Knee Documentation Committee score were not observed.
UNASSIGNED: To (1) perform a meta-analysis of comparative trials to determine whether differences in clinical outcomes and adverse events exist between ACL repair versus ACLR and (2) synthesize the midterm outcomes of available trials.
UNASSIGNED: Systematic review; Level of evidence, 3.
UNASSIGNED: The PubMed, OVID/Medline, and Cochrane databases were queried in August 2023 for prospective and retrospective clinical trials comparing ACL repair and ACLR. Data pertaining to tear location, surgical technique, adverse events, and clinical outcome measures were recorded. DerSimonian-Laird random-effects models were constructed to quantitatively evaluate the association between ACL repair/ACLR, adverse events, and clinical outcomes. A subanalysis of minimum 5-year outcomes was performed.
UNASSIGNED: Twelve studies (893 patients; 464 ACLR and 429 ACL repair) were included. Random-effects models demonstrated a higher relative risk (RR) of recurrent instability/clinical failure (RR = 1.64; 95% confidence interval [CI], 1.04-2.57; P = .032), revision ACLR (RR = 1.63; 95% CI, 1.03-2.59; P = .039), and hardware removal (RR = 4.94; 95% CI, 2.10-11.61; P = .0003) in patients who underwent primary ACL repair versus ACLR. The RR of reoperations and complications (knee-related) were not significantly different between groups. No significant differences were observed when comparing patient-reported outcome scores. In studies with minimum 5-year outcomes, no significant differences in adverse events or Lysholm scores were observed.
UNASSIGNED: In contemporary comparative trials of ACL repair versus ACLR, the RR of clinical failure, revision surgery due to ACL rerupture, and hardware removal was greater for primary ACL repair compared with ACLR. There were no observed differences in patient-reported outcome scores, reoperations, or knee-related complications between approaches. In the limited literature reporting on minimum 5-year outcomes, significant differences in adverse events or the International Knee Documentation Committee score were not observed.
摘要：
■前交叉韧带（ACL）修复在选择的近端或中质ACL撕裂患者中心获得了新的兴趣。因此,重要的是重新评估ACL修复的当代临床结局,以确定临床获益是否超过ACL重建金标准(ACLR).
对（1）进行比较试验的荟萃分析，以确定ACL修复与ACLR之间是否存在临床结局和不良事件的差异，以及（2）综合现有试验的中期结局。
■系统评价；证据水平，3.
■PubMed，OVID/Medline,和Cochrane数据库于2023年8月查询了比较ACL修复和ACLR的前瞻性和回顾性临床试验。与撕裂位置有关的数据，外科技术,不良事件,并记录临床结局指标。DerSimonian-Laird随机效应模型被构建以定量评估ACL修复/ACLR之间的关联。不良事件,和临床结果。对至少5年结局进行亚分析。
■纳入了12项研究（893例患者；464例ACLR和429例ACL修复）。随机效应模型显示复发性不稳定/临床失败的相对风险（RR）较高（RR=1.64；95％置信区间[CI]，1.04-2.57；P=.032)，修订ACLR(RR=1.63；95%CI，1.03-2.59；P=0.039)，和硬件去除（RR=4.94;95％CI，2.10-11.61;P=.0003）在接受原发性ACL修复与ACLR的患者中。两组之间的再手术RR和并发症（膝关节相关）没有显着差异。当比较患者报告的结果评分时,没有观察到显著差异。在至少5年结果的研究中，不良事件或Lysholm评分无显著差异.
■在ACL修复与ACLR的当代比较试验中，临床失败的RR，由于ACL再破裂而进行的翻修手术，与ACLR相比，主ACL修复的硬件删除更多。患者报告的结果评分没有观察到差异，重新操作,或方法之间与膝盖相关的并发症。在报道至少5年结局的有限文献中，未观察到不良事件或国际膝关节文献委员会评分的显著差异.
对（1）进行比较试验的荟萃分析，以确定ACL修复与ACLR之间是否存在临床结局和不良事件的差异，以及（2）综合现有试验的中期结局。
■系统评价；证据水平，3.
■PubMed，OVID/Medline,和Cochrane数据库于2023年8月查询了比较ACL修复和ACLR的前瞻性和回顾性临床试验。与撕裂位置有关的数据，外科技术,不良事件,并记录临床结局指标。DerSimonian-Laird随机效应模型被构建以定量评估ACL修复/ACLR之间的关联。不良事件,和临床结果。对至少5年结局进行亚分析。
■纳入了12项研究（893例患者；464例ACLR和429例ACL修复）。随机效应模型显示复发性不稳定/临床失败的相对风险（RR）较高（RR=1.64；95％置信区间[CI]，1.04-2.57；P=.032)，修订ACLR(RR=1.63；95%CI，1.03-2.59；P=0.039)，和硬件去除（RR=4.94;95％CI，2.10-11.61;P=.0003）在接受原发性ACL修复与ACLR的患者中。两组之间的再手术RR和并发症（膝关节相关）没有显着差异。当比较患者报告的结果评分时,没有观察到显著差异。在至少5年结果的研究中，不良事件或Lysholm评分无显著差异.
■在ACL修复与ACLR的当代比较试验中，临床失败的RR，由于ACL再破裂而进行的翻修手术，与ACLR相比，主ACL修复的硬件删除更多。患者报告的结果评分没有观察到差异，重新操作,或方法之间与膝盖相关的并发症。在报道至少5年结局的有限文献中，未观察到不良事件或国际膝关节文献委员会评分的显著差异.
