目的:比较临床结果,膝关节稳定性和并发症,失败,在短期和中期随访中,前交叉韧带修复(ACLr)和动态内稳定(DIS)与前交叉韧带重建(ACLR)和自体腿筋移植治疗原发性ACL破裂后的翻修率。
方法:对PubMed/MEDLINE和Scopus进行系统评价和符合Meta分析的系统评价的首选报告项目。考虑纳入评估接受DISACLr或自体腿筋移植物ACLR的患者的研究。如果患者受到伴随半月板的影响,则排除研究。韧带,或者软骨损伤需要手术治疗,因为它们对术后结局的潜在混杂作用。在纳入的研究中,使用风险偏倚-2工具评估偏倚风险。可用证据的质量根据建议评估等级进行评级,发展,和评价建议。研究方案在PROSPERO数据库(ID:CRD42023394558)中注册。
结果:5项随机对照试验比较ACLr与DIS对比ACLR与自体腿筋移植的结果符合纳入标准。在患者报告的结果方面没有重大差异(国际膝关节文献委员会主观表格,Lysholm得分,Tegner活动量表,膝关节损伤和骨关节炎结果评分,视觉模拟量表满意度)或并发症发生率,修订,在所有时间点的纳入研究中均发现失败.在一项研究中,修复显示国际膝关节文献委员会在5年时的主观形式得分更高,而在2项不同的研究中,ACLR在6个月和5年时表现出显著增加的膝关节稳定性,尽管这些差异的临床相关性值得怀疑。
结论:这项研究的结果表明,就临床结局率而言,DIS的ACLr不逊于自体腿筋移植物的ACLR。膝关节稳定性,失败的风险,并发症,和翻修手术。因此,在选定的患者中,带有DIS的ACLr可能是带有腿筋自体移植物的ACLR的可行替代方案。
方法:一级,对I级研究的系统评价。
OBJECTIVE: To compare clinical outcomes, knee stability and complications, failure, and revision rates after anterior cruciate ligament repair (ACLr) with dynamic intraligamentary stabilization (DIS) versus anterior cruciate ligament reconstruction (ACLR) with hamstring autograft for primary ACL ruptures at short and mid-term follow-up.
METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic
review of PubMed/MEDLINE and Scopus was performed. Studies that evaluated patients undergoing ACLr with DIS or ACLR with hamstring autograft were considered for inclusion. Studies were excluded if patients were affected by concomitant meniscal, ligamentous, or chondral injuries needing surgical treatment, because of their potential confounding effect on postoperative outcomes. The Risk of Bias-2 tool was used to assess the risk of bias in the included studies. The quality of available evidence was rated according to Grading of Recommendations Assessment, Development, and Evaluation recommendations. The study protocol was registered in the PROSPERO database (ID: CRD42023394558).
RESULTS: Five randomized controlled trials comparing the outcomes of ACLr with DIS versus ACLR with hamstring autograft met the inclusion criteria. No major differences in terms of patient-reported outcomes (International Knee Documentation Committee subjective form, Lysholm score, Tegner activity scale, Knee injury and Osteoarthritis Outcome Score, visual analog scale satisfaction) or rates of complications, revisions, and failures were found in included studies at all time points. Repair showed greater International Knee Documentation Committee subjective form scores at 5 years in one study, whereas ACLR displayed significantly increased knee stability at 6 months and 5 years in 2 different studies, although the clinical relevance of these differences is doubtful.
CONCLUSIONS: The results of this study suggest that ACLr with DIS is not inferior to ACLR with hamstring autograft in terms of rates of clinical outcomes, knee stability, risk of failure, complications, and revision surgery. Therefore, ACLr with DIS may be a viable alternative to ACLR with hamstring autograft in selected patients.
METHODS: Level I, systematic
review of Level I studies.