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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis
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Clinical Outcome Evaluation of Anatomic Anterior Cruciate Ligament Reconstruction With Tunnel Positioning Using Gold Standard Techniques: A Systematic Review and Meta-analysis

机译：用金标准技术与隧道定位解剖前十字韧带重建的临床结果评价：系统评价与荟萃分析

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Background: There have been conflicting results about the theoretical advantages of anatomic double-bundle anterior cruciate ligament (ACL) reconstruction. Purpose: To evaluate the clinical and functional outcomes comparing anatomic single- versus double-bundle techniques, anatomic versus nonanatomic techniques, and transportal versus outside-in tunnel drilling for ACL reconstruction. Study Design: Systematic review; Level of evidence, 3. Methods: A search was performed in the MEDLINE and EMBASE databases up to August 2018 for clinical trials comparing anatomic ACL reconstruction (with tunnel positioning demonstrated using gold standard radiologic techniques) with another technique, with a minimum functional and biomechanical follow-up of 6 months. A meta-analysis was performed to compare clinical and functional outcomes between anatomic single- versus double-bundle reconstruction and between anatomic versus nonanatomic techniques, using the risk difference or the mean difference. Risk of bias of the included studies was assessed using the Newcastle-Ottawa Scale for cohort and case-control studies and the Cochrane Risk of Bias tool and Jadad Score?for randomized controlled trials. Results: Included were 15 studies comprising 1290 patients (follow-up, 12-36 months). No significant differences favoring anatomic double-bundle over anatomic single-bundle reconstruction or outside-in over transportal techniques were found. The meta-analyses showed significant differences in the International Knee Documentation Committee (IKDC) objective score (risk difference,?–0.14; 95% confidence interval, –0.27 to?–0.01) favoring anatomic over nonanatomic reconstruction. No statistically significant differences were found between anatomic and nonanatomic surgical techniques on other functional scores or clinical examination outcomes, including the IKDC subjective score, Lysholm score, Tegner score, KT-1000 arthrometer test, or pivot-shift test. Conclusion: Double-bundle reconstruction was not superior to the single-bundle technique in clinical and functional outcomes. Anatomic ACL reconstruction shows significantly superior results over nonanatomic ACL reconstruction, reinforcing the anatomic technique as the gold standard choice for clinical practice.
机译：背景：对解剖双束前十字韧带（ACL）重建的理论优势存在矛盾的结果。目的：评估与ACL重建的解剖学单束技术，解剖学与双束技术，解剖学与非抗体技术的临床和功能结果进行比较。研究设计：系统评论;证据级别，3.方法：在Medline和Embase数据库中进行搜索到2018年8月，用于比较解剖学ACL重建的临床试验（使用金标准放射学技术用隧道定位）与另一种技术，具有最小的功能和生物力学随访6个月。进行META分析以比较原子学单束重建与解剖学与非抗体技术之间的临床和功能结果，使用风险差异或平均差异。使用纽卡斯尔 - 渥太华规模评估包括队渥太华的群体和案例控制研究的风险以及偏见工具和Jadad评分的Cochrane风险？用于随机对照试验。结果：包括12项研究，包括1290名患者（后续12-36个月）。发现没有显着差异，有利于解剖双束在解剖学单束重建或外部运输技术外。 Meta-Analyzes在国际膝关节委员会（IKDC）客观评分（风险差异，？ - 0.14; 95％置信区间，-0.27至-0.01）中有利于非致原因重建的巨大差异。在其他功能评分或临床检查结果上没有发现解剖学和非致原子外科或临床检查结果之间没有统计学意义，包括IKDC主观评分，Lysholm评分，Tegner评分，KT-1000节奏计测试或枢转换档测试。结论：双束重建在临床和功能结果中的单束技术不优于单束技术。解剖学ACL重建显示出显着优异的非致原ACL重建结果，加强了解剖技术作为临床实践的黄金标准选择。

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