Lewis Paul B, Parameswaran A Dushi, Rue John-Paul H, Bach Bernard R
Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60612, USA.
Am J Sports Med. 2008 Oct;36(10):2028-36. doi: 10.1177/0363546508322892. Epub 2008 Aug 29.
There is increasing interest in comparing the efficacy of single-bundle versus double-bundle anterior cruciate ligament reconstruction. Challenging this comparison, however, has been the lack of an established consensus on the success of single-bundle reconstruction.
The current outcomes of single-bundle reconstruction can be clarified from a large unbiased body of evidence for future comparisons with double-bundle reconstructions.
Systematic review.
A systematic review of 11 randomized, controlled trials comparing patellar tendon and hamstring tendon grafting is reported. The respective outcomes of each group were combined to assist the orthopaedic surgeon in assessing the current success of single-bundle reconstruction. The primary factors assessed were tibial subluxation and side-to-side differences in laxity. Secondary outcomes included concomitant injuries and treatments, complications, graft failure, range of motion, and radiographic evidence of degenerative changes.
In this review of 1024 single-bundle anterior cruciate ligament reconstructions, 495 concomitant meniscal tears, 95 chondral injuries, and 2 posterior cruciate ligament tears were noted. The complication rate was 6%, and graft failure 4%. Reported pivot-shift test results were negative in 81% of cases; reported Lachman tests were negative in 59% cases; and KT-1000 arthrometer side-to-side differences were <or= 5 mm in 86% of cases. Flexion and extension deficits were reported in 9 of 11 studies through mean range of motion or deficit ranges. Radiographic changes of articular surface abnormalities were observed in 7% of the knees at follow-up investigation.
Systematic review of a significant body of unbiased outcome data on single-bundle anterior cruciate ligament reconstruction demonstrates it to be a safe, consistent surgical procedure affording reliable results.
These results may be used to assist orthopaedic surgeons in evaluating the benefit and practicality of pursuing new anterior cruciate ligament reconstruction techniques over standard single-bundle anterior cruciate ligament reconstruction.
比较单束与双束前交叉韧带重建的疗效越来越受到关注。然而，对单束重建成功与否缺乏既定的共识给这种比较带来了挑战。
可以从大量无偏倚的证据中明确单束重建的当前结果，以便未来与双束重建进行比较。
系统评价。
报道了一项对11项比较髌腱和腘绳肌腱移植的随机对照试验的系统评价。将每组的各自结果合并，以帮助骨科医生评估单束重建目前的成功率。评估的主要因素是胫骨半脱位和松弛度的左右差异。次要结果包括伴随损伤和治疗、并发症、移植物失败、活动范围以及退变改变的影像学证据。
在这项对1024例单束前交叉韧带重建的评价中，发现495例伴有半月板撕裂、95例软骨损伤和2例后交叉韧带撕裂。并发症发生率为6%，移植物失败率为4%。报告的轴移试验结果在81%的病例中为阴性；报告的拉赫曼试验在59%的病例中为阴性；并且在86%的病例中，KT-1000关节测量仪测量的左右差异≤5mm。11项研究中有9项通过平均活动范围或活动范围缺失报告了屈伸功能障碍。在随访调查中，7%的膝关节观察到关节面异常的影像学改变。
对大量关于单束前交叉韧带重建的无偏倚结果数据进行系统评价表明，它是一种安全、稳定的手术方法，能提供可靠的结果。
这些结果可用于帮助骨科医生评估采用新的前交叉韧带重建技术相对于标准单束前交叉韧带重建的益处和实用性。
