为了确定在前交叉韧带重建(ACLR)中增加外侧关节外肌腱固定术(LET)是否可以减少膝关节的旋转松弛,并比较该治疗与单独ACLR的临床效果。
PubMed,Embase,和Cochrane图书馆由两名研究人员搜索,以进行比较有和没有LET的ACLR的临床研究。排除仅具有I级和II级证据的研究以及使用移植物进行前外侧韧带重建的研究。使用Cochrane偏差风险和改良的Downs&Black工具评估了研究的偏差风险。结果包括(1)功能结果;(2)膝关节松弛度测量;(3)膝关节损伤骨关节炎和结果评分;(4)并发症。提取两组的结果,总结和比较。
共检索了234项研究,排除了223项。我们的荟萃分析包括了11项涉及1745例患者的临床研究。与单独接受ACLR的患者相比,接受LET的ACLR患者的枢轴移位减少(比值比[OR]0.48,95%置信区间[CI]0.31至0.74,p=0.0009),移植物失败率较低(OR0.34,95%CI0.20至0.55,p<0.0001)。
与仅ACLR相比,ACLR联合LET能有效减少膝关节的旋转松弛,并降低高危患者的移植物失败率。然而,对患者功能和活动水平的影响无法证实。
To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) reduces rotational laxity of the knee, and to compare the clinical results of this treatment with those of ACLR alone.
PubMed, Embase, and Cochrane Library were searched by two researchers for clinical studies comparing ACLR with and without LET. Studies with only evidence levels I and II and studies in which anterior lateral ligament reconstruction was performed with grafts were excluded. The risk of bias of the studies was assessed using the Cochrane risk-of-bias and modified Downs & Black tools. The outcomes included (1) functional outcomes; (2) knee laxity measures; (3) knee injury osteoarthritis and outcome score; and (4) complications. The outcomes of the two groups were extracted, summarized and compared.
A total of 234 studies were retrieved and 223 were excluded. Eleven clinical studies with 1745 patients were included in our meta-analysis. Compared to the patients who underwent ACLR alone, the patients who underwent ACLR with LET had reduced pivot-shift (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.31 to 0.74, p = 0.0009), and lower graft failure rate (OR 0.34, 95% CI 0.20 to 0.55, p < 0.0001).
Compared with ACLR only, ACLR combined with LET can effectively reduce rotation laxity of the knee joint, and reduce the graft failure rate in high-risk patients. However, the effects on the function and activity level of patients cannot be confirmed.