■自1990年代以来,前交叉韧带(ACL)重建一直是主要ACL破裂的金标准。在过去的十年里,ACL修复受到了新的关注和更多的研究。
■比较现代增强ACL修复与自体移植重建治疗ACL破裂的临床结果。
■系统评价;证据水平,3.
■搜索PubMed,EMBASE,Scopus,WebofScience,2010年1月1日至2023年1月3日,对CochraneLibrary数据库进行前瞻性或回顾性比较研究,至少随访2年.两名独立的审查员进行了数据提取和方法学质量评估。进行灵敏度分析以保持结果的稳定性。
■纳入了9项研究(最短随访期,24-60个月)。总样本量为833例患者(增强修复组:358例患者;自体移植ACL重建组:475例患者)。有4项随机对照试验(1级),1项前瞻性比较研究(2级),2个回顾性比较研究(3级),和2个病例对照研究(3级)。增强ACL修复组获得了更高的Lysholm评分(加权平均差[WMD]=1.57;95%置信区间[CI],0.14-3.01;P=.03)和腿筋强度(WMD=36.69;95%CI,29.07-44.31;P<.01),但硬件去除率较高(比值比[OR]=6.30;95%CI,2.44-16.23;P=.0001),再次手术(OR=1.87;95%CI,1.33-2.62;P=.0003),与自体移植ACL重建组相比,失败(OR=1.58;95%CI,1.03-2.43;P=.0003)。修复组和重建组术后国际膝关节文献委员会评分无显著差异,Tegner得分,膝盖松弛,满意,ACL修订,并发症,重新操作而不是修改。
■增强ACL修复与更高的再手术率相关,硬件拆卸,在至少2年随访数据的研究中,与自体移植ACL重建相比失败。然而,与自体移植ACL重建相比,增强ACL修复的Lysholm评分和腿筋强度更高。
UNASSIGNED: Anterior cruciate ligament (ACL) reconstruction has been the gold standard for primary ACL rupture since the 1990s. In the past decade, ACL repair has received renewed attention and increased research.
UNASSIGNED: To compare the clinical outcomes of modern augmented ACL repair versus
autograft reconstruction for ACL ruptures.
UNASSIGNED: Systematic review; Level of evidence, 3.
UNASSIGNED: A search of the PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library databases was conducted for prospective or retrospective comparative studies published between January 1, 2010, and January 3, 2023, with a minimum 2-year follow-up. Two independent reviewers performed data extraction and methodological quality assessment. Sensitivity analysis was performed to maintain the stability of results.
UNASSIGNED: Nine studies were included (minimum follow-up period, 24-60 months). The total sample size was 833 patients (augmented repair group: 358 patients;
autograft ACL reconstruction group: 475 patients). There were 4 randomized controlled trials (level 1), 1 prospective comparative study (level 2), 2 retrospective comparative studies (level 3), and 2 case-control studies (level 3). The augmented ACL repair group attained significantly higher Lysholm score (weighted mean difference [WMD] = 1.57; 95% confidence interval [CI], 0.14-3.01; P = .03) and hamstring strength (WMD = 36.69; 95% CI, 29.07-44.31; P < .01) but had higher rates of hardware removal (odds ratio [OR] = 6.30; 95% CI, 2.44-16.23; P = .0001), reoperation (OR = 1.87; 95% CI, 1.33-2.62; P = .0003), and failure (OR = 1.58; 95% CI, 1.03-2.43; P = .0003) compared with the
autograft ACL reconstruction group. No significant differences were observed between the repair and reconstruction groups regarding postoperative International Knee Documentation Committee scores, Tegner scores, knee laxity, satisfaction, ACL revisions, complications, and reoperation rather than revision.
UNASSIGNED: Augmented ACL repair was associated with higher rates of reoperation, hardware removal, and failure compared with
autograft ACL reconstruction in studies with minimum 2-year follow-up data. However, augmented ACL repair had higher Lysholm scores and hamstring strength versus
autograft ACL reconstruction.