Samuelsson Kristian, Andersson Daniel, Karlsson Jón
Department of Orthopaedics, Sahlgrenska University Hospital, SE-431 80, Mölndal, Sweden.
Arthroscopy. 2009 Oct;25(10):1139-74. doi: 10.1016/j.arthro.2009.07.021.
The primary aim was to summarize and assess current evidence from randomized controlled trials (RCTs) on anterior cruciate ligament injuries, with special reference to graft type and surgical technique. The secondary aims were to identify the relative strengths and weaknesses of the selected studies, to resolve contradictions in the literature, and to evaluate the need for further studies.
A PubMed database search using the key words "anterior cruciate ligament" was performed. The search was limited to RCTs published in English between January 1995 and March 2009. Articles on the subject of graft type and surgical technique were identified. After initial screening and a subsequent quality appraisal based on the CONSORT (Consolidated Standards of Reporting Trials) Statement, a total of 39 articles were included in this review.
There are no differences between the bone-patellar tendon-bone (BPTB) graft and the hamstring tendon (HT) graft in terms of laxity, clinical outcome, time to return to sports, patellofemoral crepitations, 1-leg hop test, range of motion, thigh muscle circumference, or anterior knee sensory deficit. The BPTB graft produces more anterior knee pain and kneeling pain than the HT graft, but the difference disappears with time. The harvest site affects muscle strength initially but not over time. There is a possible correlation between the development of osteoarthritis and the BPTB graft. The HT graft produces more tunnel widening than the BPTB graft, but there is no correlation between tunnel widening and clinical outcome or laxity. The semitendinosus and gracilis graft is associated with inferior knee flexion at higher angles, as compared with the semitendinosus graft. There are probably no differences between the BPTB graft and the bone-HT-bone graft in terms of laxity and clinical outcome. Semitendinosus and gracilis tendon harvesting probably reduces hamstring muscle strength for approximately 1 year. Double-bundle reconstruction produces less rotatory laxity than single-bundle reconstruction. Double-bundle reconstruction by use of an 8-strand HT graft probably produces less laxity than single-bundle reconstruction. There are no differences in clinical outcome when single-bundle and double-bundle anterior cruciate ligament reconstructions are compared.
In the quality assessment several weaknesses in the study design of the RCTs were found. This emphasizes the need for further high-quality studies, especially with long-term follow-up.
Level II, systematic review of randomized controlled trials.
主要目的是总结和评估来自随机对照试验（RCT）的关于前交叉韧带损伤的现有证据，特别涉及移植物类型和手术技术。次要目的是确定所选研究的相对优势和劣势，解决文献中的矛盾之处，并评估进一步研究的必要性。
使用关键词“前交叉韧带”对PubMed数据库进行检索。检索限于1995年1月至2009年3月间以英文发表的RCT。确定了关于移植物类型和手术技术主题的文章。经过初步筛选以及随后基于CONSORT（试验报告统一标准）声明进行的质量评估，本综述共纳入39篇文章。
在松弛度、临床结果、恢复运动时间、髌股关节摩擦音、单腿跳测试、活动范围、大腿肌肉周长或前膝感觉缺失方面，骨-髌腱-骨（BPTB）移植物与腘绳肌腱（HT）移植物之间没有差异。BPTB移植物比HT移植物产生更多的前膝疼痛和跪痛，但这种差异会随着时间消失。取材部位最初会影响肌肉力量，但随着时间推移不会。骨关节炎的发展与BPTB移植物之间可能存在相关性。HT移植物比BPTB移植物产生更多的隧道增宽，但隧道增宽与临床结果或松弛度之间没有相关性。与半腱肌移植物相比，半腱肌和股薄肌移植物在较高角度时膝关节屈曲较差。在松弛度和临床结果方面，BPTB移植物与骨-腘绳肌腱-骨移植物之间可能没有差异。半腱肌和股薄肌腱取材可能会使腘绳肌力量降低约1年。双束重建比单束重建产生的旋转松弛度更小。使用8股HT移植物进行双束重建可能比单束重建产生的松弛度更小。比较单束和双束前交叉韧带重建时，临床结果没有差异。
在质量评估中发现RCT的研究设计存在若干弱点。这强调了进行进一步高质量研究的必要性，尤其是长期随访研究。
II级，随机对照试验的系统评价。
